Japanese Journal of Clinical Oncology Advance Access published online on June 23, 2008
Japanese Journal of Clinical Oncology, doi:10.1093/jjco/hyn049
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© The Author (2008). Published by Oxford University Press. All rights reserved
Low-dose Craniospinal Irradiation and Ifosfamide, Cisplatin and Etoposide for Non-metastatic Embryonal Tumors in the Central Nervous System
1 Department of Radiology, Hokkaido University School of Medicine
2 Department of Neurosurgery, Hokkaido University School of Medicine
3 Department of Pediatrics, Hokkaido University School of Medicine
4 Department of Otolaryngology, Hokkaido University School of Medicine, Sapporo, Japan
For reprints and all correspondence: Koichi Yasuda, Hokkaido University School of Medicine, North-15 West-7, Kita-ku, Sapporo, Japan. E-mail: kyasuda{at}radi.med.hokudai.ac.jp
Received February 5, 2008; accepted May 26, 2008
Objective: The current study was conducted to evaluate the effects of low-dose craniospinal irradiation (CSI) combined with chemotherapy on non-metastatic embryonal tumors in the central nervous system (CNS), including medulloblastoma and supra-tentorial primitive neuroectodermal tumors (ST-PNET).
Methods: All patients were treated according to the following protocol. After surgery, the patients 
5 years old received 18 Gy and the patients >5 years old received 24 Gy CSI. The dose to the primary tumor bed was 39.6–54 Gy. Chemotherapy consisted of ifosfamide, cisplatin and etoposide (ICE chemotherapy).
Results: Sixteen patients aged 0.5–20.4 (median 6.1) years were enrolled and followed for 11–165 (median 112) months. Both 5-year actuarial overall survival (OAS) and progression-free survival (PFS) were 81% (95% confidence interval (CI): 62–100%) for the 16 patients. Both 5-year OAS and PFS were 82% (CI: 59–100%) for the patients with medulloblastoma and 80% (CI: 45–100%) for the patients with ST-PNET. Both 5-year OAS and PFS were 75% for the eight patients 5 years old and 88% for the eight patients >5 years old. Both 5-year OAS and PFS were 100% for six average-risk patients (3 years or older, total resection and posterior fossa) and 70% for 10 poor-risk patients (others). The median total intellectual quotient at the last follow-up was 85 (ranging from 48 to 103) in 12 patients who were followed for 3–145 (median 49) months. Eight patients received hormone replacement therapy.
Conclusion: Low-dose CSI and ICE chemotherapy may have a role as a treatment option for a subset of patients with non-metastatic embryonal tumors in the CNS.
Key Words: medulloblastoma • primitive neuroectodermal tumor • chemotherapy • radiotherapy • late effect
Presented in part at the 49th annual meeting of the American Society of Therapeutic Radiology and Oncology in October 2007.