• Birgitta Lannering, Stefan Rutkowski, Francois Doz, Barry Pizer, Göran Gustafsson, Aurora Navajas, Maura Massimino, Roel Reddingius, Martin Benesch, Christian Carrie, Roger Taylor, Lorenza Gandola, Thomas Björk-Eriksson, Jordi Giralt, Foppe Oldenburger, Torsten Pietsch, Dominique Figarella-Branger, Keith Robson, Marco Forni, Steven C Clifford, Monica Warmuth-Metz, Katja von Hoff, Andreas Faldum, Véronique Mosseri, and Rolf Kortmann.
• Department of Pediatrics, University of Gothenburg, The Queen Silvia Children's Hospital, S 41685 Göteborg, Sweden. birgitta.lannering@vgregion.se
• J. Clin. Oncol. 2012 Sep 10; 30 (26): 3187-93.

PurposeTo compare event-free survival (EFS), overall survival (OS), pattern of relapse, and hearing loss in children with standard-risk medulloblastoma treated by postoperative hyperfractionated or conventionally fractionated radiotherapy followed by maintenance chemotherapy.Patients And MethodsIn all, 340 children age 4 to 21 years from 122 European centers were postoperatively staged and randomly assigned to treatment with hyperfractionated radiotherapy (HFRT) or standard (conventional) fractionated radiotherapy (STRT) followed by a common chemotherapy regimen consisting of eight cycles of cisplatin, lomustine, and vincristine.ResultsAfter a median follow-up of 4.8 years (range, 0.1 to 8.3 years), survival rates were not significantly different between the two treatment arms: 5-year EFS was 77% ± 4% in the STRT group and 78% ± 4% in the HFRT group; corresponding 5-year OS was 87% ± 3% and 85% ± 3%, respectively. A postoperative residual tumor of more than 1.5 cm(2) was the strongest negative prognostic factor. EFS of children with all reference assessments and no large residual tumor was 82% ± 2% at 5 years. Patients with a delay of more than 7 weeks to the start of RT had a worse prognosis. Severe hearing loss was not significantly different for the two treatment arms at follow-up.ConclusionIn this large randomized European study, which enrolled patients with standard-risk medulloblastoma from more than 100 centers, excellent survival rates were achieved in patients without a large postoperative residual tumor and without RT treatment delays. EFS and OS for HFRT was not superior to STRT, which therefore remains standard of care in this disease.

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