Long-term outcome and clinical prognostic factors in children with medulloblastoma treated in the prospective randomised multicentre trial HIT‘91

Hoff, Katja von; Hinkes, Bernward; Gerber, Nicolas U.; Deinlein, Frank; Mittler, Uwe; Urban, Christian; Benesch, Martin; Warmuth-Metz, Monika; Soerensen, Niels; Zwiener, Isabella; Goette, Heiko; Schlegel, Paul G.; Pietsch, Torsten; Kortmann, Rolf D.; Kuehl, Joachim; Rutkowski, Stefan

doi:10.1016/j.ejca.2009.01.015

« Previous Next »European Journal of Cancer
Volume 45, Issue 7 , Pages 1209-1217, May 2009

Long-term outcome and clinical prognostic factors in children with medulloblastoma treated in the prospective randomised multicentre trial HIT‘91

Katja von Hoff
- Department of Pediatrics, University of Wuerzburg, Germany
Bernward Hinkes
- Department of Pediatrics, University of Wuerzburg, Germany
Nicolas U. Gerber
- Department of Pediatrics, University of Wuerzburg, Germany
Frank Deinlein
- Department of Pediatrics, University of Wuerzburg, Germany
Uwe Mittler
- University Children’s Hospital of Magdeburg, Germany
Christian Urban
- Division of Paediatric Haematology and Oncology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria
Martin Benesch
- Division of Paediatric Haematology and Oncology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Austria
Monika Warmuth-Metz
- Department of Neuroradiology, University of Wuerzburg, Germany
Niels Soerensen
- Department of Neurosurgery, ev. Hospital Oldenburg, Germany
Isabella Zwiener
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany
Heiko Goette
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), University of Mainz, Germany
Paul G. Schlegel
- Department of Pediatrics, University of Wuerzburg, Germany
Torsten Pietsch
- Department of Neuropathology, University of Bonn, Germany
Rolf D. Kortmann
- Department of Radiation Oncology, University of Leipzig, Germany
Joachim Kuehl
- Department of Pediatrics, University of Wuerzburg, Germany
Stefan Rutkowski
- Department of Pediatrics, University of Wuerzburg, Germany
- University Medical Center Hamburg-Eppendorf, Department of Pediatric Hematology and Oncology, Hamburg, Germany
- Corresponding author. Tel.: +49 40 7410 54270; fax: +49 40 7410 54601.

Received 24 November 2008; accepted 15 January 2009. published online 02 March 2009.

Abstract

Purpose

To analyse long-term outcome and clinical prognostic factors in medulloblastoma.

Methods

We analysed 280 patients with medulloblastoma (3–18 years) included from 1991 to 1997 in the randomised multicentre trial HIT‘91 comparing pre-(‘sandwich’) and postradiation (‘maintenance’) chemotherapy (median follow-up of survivors for 10 years).

Results

In 187 patients with complete staging, overall survival (OS) was higher after maintenance compared to sandwich treatment for M0 (10-year OS 91% and 62%, p=0.001) and M1 patients (10-year OS 70% and 34%, p=0.020). In M2/3 disease, 10-year OS was 42% and 45%. Incomplete staging, metastases, younger age and sandwich chemotherapy were independent adverse risk factors. Twelve percent of all relapses (13 of 107) occurred after more than five years, and 12 patients had secondary neoplasms.

Conclusions

After maintenance therapy, long-term survival was excellent in fully assessable patients with localised medulloblastoma, and favourable for M1 patients. Patients should be followed longer for late relapses and secondary tumours.

Keywords: Medulloblastoma, Children, Treatment outcome, Second neoplasm