Home > Publications Database > Nonmetastatic Medulloblastoma of Early Childhood: Results From the Prospective Clinical Trial HIT-2000 and An Extended Validation Cohort > print

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100 1 _ |a Mynarek, Martin
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245 _ _ |a Nonmetastatic Medulloblastoma of Early Childhood: Results From the Prospective Clinical Trial HIT-2000 and An Extended Validation Cohort
260 _ _ |a Alexandria, Va.
|c 2020
|b American Society of Clinical Oncology
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520 _ _ |a PURPOSEThe HIT-2000-BIS4 trial aimed to avoid highly detrimental craniospinal irradiation (CSI) in children < 4 years of age with nonmetastatic medulloblastoma by systemic chemotherapy, intraventricular methotrexate, and risk-adapted local radiotherapy.PATIENTS AND METHODSFrom 2001-2011, 87 patients received systemic chemotherapy and intraventricular methotrexate. Until 2006, CSI was reserved for nonresponse or progression. After 2006, local radiotherapy was introduced for nonresponders or patients with classic medulloblastoma (CMB) or large-cell/anaplastic medulloblastoma (LCA). DNA methylation profiles of infantile sonic hedgehog-activated medulloblastoma (SHH-INF) were subdivided into iSHH-I and iSHH-II subtypes in the HIT-2000-BIS4 cohort and a validation cohort (n = 71) from the HIT group and Russia.RESULTSFive years after diagnosis, patients with desmoplastic medulloblastoma (DMB) or medulloblastoma with extensive nodularity (MBEN; n = 42) had 93% progression-free survival (5y-PFS), 100% overall survival (5y-OS), and 93% CSI-free (5y-CSI-free) survival. Patients with CMB/LCA (n = 45) had 37% 5y-PFS, 62% 5y-OS, and 39% 5y-CSI-free survival. Local radiotherapy did not improve survival in patients with CMB/LCA. All DMB/MBEN assessed by DNA methylation profiling belonged to the SHH-INF subgroup. Group 3 patients (5y-PFS, 36%; n = 14) relapsed more frequently than the SHH-INF group (5y-PFS, 93%; n = 28) or group 4 patients (5y-PFS, 83%; n = 6; P < .001). SHH-INF split into iSHH-I and iSHH-II subtypes in HIT-2000-BIS4 and the validation cohort, without prognostic impact (5y-PFS: iSHH-I, 73%, v iSHH-II, 83%; P = .25; n = 99). Intelligence quotient (IQ) was significantly lower in patients after CSI (mean IQ, 90 [no radiotherapy], v 74 [CSI]; P = .012).CONCLUSIONSystemic chemotherapy and intraventricular methotrexate led to favorable survival in both iSHH subtypes of SHH-activated DMB/MBEN with acceptable neurotoxicity. Survival in patients with non-wingless (WNT)/non-SHH disease with CMB/LCA was not improved by local radiotherapy. Patients with group 4 disease had more favorable survival rates than those with group 3 medulloblastoma.
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650 _ 2 |a Cerebellar Neoplasms: drug therapy
|2 MeSH
650 _ 2 |a Cerebellar Neoplasms: mortality
|2 MeSH
650 _ 2 |a Cerebellar Neoplasms: radiotherapy
|2 MeSH
650 _ 2 |a Child, Preschool
|2 MeSH
650 _ 2 |a Cranial Irradiation: adverse effects
|2 MeSH
650 _ 2 |a DNA Methylation
|2 MeSH
650 _ 2 |a Female
|2 MeSH
650 _ 2 |a Humans
|2 MeSH
650 _ 2 |a Infant
|2 MeSH
650 _ 2 |a Male
|2 MeSH
650 _ 2 |a Medulloblastoma: drug therapy
|2 MeSH
650 _ 2 |a Medulloblastoma: mortality
|2 MeSH
650 _ 2 |a Medulloblastoma: radiotherapy
|2 MeSH
650 _ 2 |a Methotrexate: administration & dosage
|2 MeSH
650 _ 2 |a Neuropsychological Tests
|2 MeSH
650 _ 2 |a Prospective Studies
|2 MeSH
700 1 _ |a von Hoff, Katja
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700 1 _ |a Pietsch, Torsten
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700 1 _ |a Ottensmeier, Holger
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700 1 _ |a Warmuth-Metz, Monika
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700 1 _ |a Bison, Brigitte
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700 1 _ |a Pfister, Stefan
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700 1 _ |a Korshunov, Andrey
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700 1 _ |a Sharma, Tanvi
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700 1 _ |a Jaeger, Natalie
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700 1 _ |a Ryzhova, Marina
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700 1 _ |a Zheludkova, Olga
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700 1 _ |a Golanov, Andrey
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700 1 _ |a Rushing, Elisabeth Jane
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700 1 _ |a Hasselblatt, Martin
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700 1 _ |a Koch, Arend
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700 1 _ |a Schüller, Ulrich
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700 1 _ |a von Deimling, Andreas
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700 1 _ |a Sahm, Felix
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700 1 _ |a Sill, Martin
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700 1 _ |a Riemenschneider, Markus J.
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700 1 _ |a Dohmen, Hildegard
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700 1 _ |a Monoranu, Camelia Maria
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700 1 _ |a Sommer, Clemens
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700 1 _ |a Staszewski, Ori
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700 1 _ |a Mawrin, Christian
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700 1 _ |a Schittenhelm, Jens
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700 1 _ |a Brück, Wolfgang
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700 1 _ |a Filipski, Katharina
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700 1 _ |a Hartmann, Christian
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700 1 _ |a Meinhardt, Matthias
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700 1 _ |a Pietschmann, Klaus
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700 1 _ |a Haberler, Christine
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700 1 _ |a Slavc, Irene
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700 1 _ |a Gerber, Nicolas U.
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700 1 _ |a Grotzer, Michael
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700 1 _ |a Benesch, Martin
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700 1 _ |a Schlegel, Paul Gerhardt
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700 1 _ |a Deinlein, Frank
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700 1 _ |a von Bueren, André O.
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700 1 _ |a Friedrich, Carsten
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700 1 _ |a Juhnke, Björn-Ole
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700 1 _ |a Obrecht, Denise
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700 1 _ |a Fleischhack, Gudrun
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700 1 _ |a Kwiecien, Robert
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700 1 _ |a Faldum, Andreas
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700 1 _ |a Kortmann, Rolf Dieter
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700 1 _ |a Kool, Marcel
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700 1 _ |a Rutkowski, Stefan
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773 _ _ |a 10.1200/JCO.19.03057
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