Skip to main content
SpringerLink
Log in

Chemotherapy for medulloblastomas and primitive neuroectodermal tumors

  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Summary

In the past two decades, chemotherapy has proven to be an increasingly more effective modality in the treatment of medulloblastoma. Current evidence suggests that chemotherapy be included as part of standard treatment for all patients with high-risk medulloblastoma. Ongoing multi-centre trials are determining whether chemotherapy should be added to reduced dose radiotherapy as a substitute therapy for standard-dose radiotherapy. The major randomized and non-randomized chemotherapy trials for newly diagnosed patients with medulloblastoma or for patients at recurrence are presented. It is hoped that the addition of chemotherapy will eventually lead to improved survival rates as well as the reduction in the craniospinal radiotherapy dose for patients with medulloblastoma.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Bruno LA, Rorke LB, Norris DG: Primitive neuroectodermal tumors of infancy and childhood. In: Humphrey GB et al. (eds) Pediatric Oncology, Volume 1. Boston, MA, Martinus Nijhoff Publishers, 1981, pp 265–267

    Google Scholar 

  2. Gaffney CC, Slone JP, Bradley NJ et al.: Primitive neuroectodermal tumours on the cerebrum (pathology and treatment). J Neurooncol 3: 23–33, 1985

    Google Scholar 

  3. Bailey P, Cushing H: Medulloblastoma cerebella: A common type of mid-cerebellar glioma of childhood. Arch Neur Psychiatr 14: 192–224, 1925

    Google Scholar 

  4. Hart MN, Earle KM: Primitive neuroectodermal tumors of the brain in children. Cancer 32: 890–897, 1973

    Google Scholar 

  5. Rorke LB: The cerebellar medulloblastoma and its relationship to primitive neuroectodermal tumors. J Neuropathol Exp Neurol 42: 1–15, 1983

    Google Scholar 

  6. Molenaar WM, Janssen D, Gould Ve et al.: Immunohistology in the diagnosis of pediatric brain tumors. Pediatr Neurosci 14: 11, 1988

    Google Scholar 

  7. Kleihues P, Burger PC, Scheithauer BW et al.: World Health Organization international classification of tumors, histological typing of tumors of the central nervous system, Springer-Verlag, Berlin, Germany, 1993

    Google Scholar 

  8. Chang CH, Housepian EM, Herbert C Jr: An operative staging system and a megavoltage radiotherapeutic technique for cerebellar medulloblastoma. Radiology 93: 1351–1359, 1969

    Google Scholar 

  9. Packer RJ, Sutton LN, D'Angio G et al.: Management of children with primitive neuroectodermal tumors of the posterior fossa/medulloblastoma. Pediatr Neurosci 12: 272–282, 1986

    Google Scholar 

  10. Packer RJ: Chemotherapy for medulloblastoma/primitive neuroectodermal tumors of the posterior fossa. Ann Neurol 28: 823–828, 1990

    Google Scholar 

  11. Evans AE, Jenkin RDT, Sposto R, Ortega JA, Wilson CB, Wara W et al.: The treatment of medulloblastoma. J Neurosurg 72: 572–582, 1990

    Google Scholar 

  12. Cohen BH, Zeltzer PM, Boyett JM, Geyer JR, Allen JC, Finlay JL et al.: Prognostic factors and treatment results for supratentorial primitive neuroectodermal tumors in children using radiation and chemotherapy. A Childrens Cancer Group randomized trial. J Clin Oncol 13: 1687–1696, 1995

    Google Scholar 

  13. Wald B, Siegel SE, Issacs H et al.: Cerebral primitive neuroectodermal tumor (primary cerebral neuroblastoma): CHLA exprience. In: Humphrey GB, Delmer LP, Grindey GB, Acton RT (eds) Pediatr Oncology. Boston, MA, Martinus Nijhoff, 1981, pp 229–134

    Google Scholar 

  14. Zeltzer P, Boyett J, Finlay J et al.: Prognostic factors for survival differ in high-risk infra- and supratentorial primitive neuroectodermal tumors. Ped Neurosurgery 19: 333, 1993

    Google Scholar 

  15. Paterson R, Farr RF: Cerebellar medulloblastoma: Treatment by irradiation of the whole central nervous system. Acta Radiol 39: 323–336, 1953

    Google Scholar 

  16. Jenkin RDT: Medulloblastoma in childhood. Radiation therapy. Can Med Assoc J 100: 51–53, 1969

    Google Scholar 

  17. Harisiadis L, Chang CH: Medulloblastoma in children: A correlation between staging and results of treatment. Int J Radiat Oncol Biol Phys 2: 833–841, 1977

    Google Scholar 

  18. Tarbell NJ, Loeffler IS, Silver B et al.: The change in patterns of relapse in medulloblastoma. Cancer 68: 1600–1604, 1991

    Google Scholar 

  19. Bloom HJG: Intracranial tumors. Response and resistance to therapeutic endeavors. Int J Radiat Oncol Biol Phys 8: 1083–1113, 1982

    Google Scholar 

  20. Radcliff J, Packer RJ, Atkins TE, Bunin GR, Schut L, Goldwein JW, Sutton LN: Three- and four-year cognitive outcome in children with noncortical brain tumors treated with whole-brain radiotherapy. Ann Neurol 32: 551–554, 1992

    Google Scholar 

  21. Deutsch M, Thomas P, Boyett J, Krischer JP, Finlay J, Kun L et al.: Low-stage medulloblastoma: A Children's Cancer Study Group (CCSG) and Pediatric Oncology Group (POG) randomized study of standard vs reduced neuraxis irradiation. Proc Annu Meet Am Soc Clin Oncol 10: A363, 1991

    Google Scholar 

  22. Mastrangelo R, Lasorella A, Riccardi R, Colosimo C, Iavarone A, Tornesello A et al.: Carboplatin in childhood medulloblastoma/PNET: Feasibility of an in vivo sensitivity test in and ‘up-front’ study. Med and Ped Oncol 214: 188–196, 1995

    Google Scholar 

  23. Friedman HS, Schold SC: Rational approaches to the chemotherapy of medulloblastoma. Neurol Clin 3: 843–854, 1985

    Google Scholar 

  24. Rosen G, Ghavimi F, Nirenberg A, Mosende C, Mehta BM: High-dose methothrexate with citrovorum factor rescue for the treatment of central nervous system tumors in children. Cancer Treat Rep 61: 781–690, 1977

    Google Scholar 

  25. Allen JC, Helson L: High-dose cyclophosphamide chemotherapy for recurrent CNS tumors in children. J Neurosurg 55: 749–756, 1981

    Google Scholar 

  26. Walker RW, Allen JC: Cisplatinum in the treatment of recurrent childhood primary brain tumors. Clin Oncol 6: 62–66, 1988

    Google Scholar 

  27. Allen JC, Walker R, Luks E et al.: Carboplatin and recurrent childhood brain tumors. J Clin Oncol 5: 459–463, 1987

    Google Scholar 

  28. Lefkowitz JB, Packer RJ, Siegel KR, Sutton LN, Schut L, Evans AE: Results of treatment of children with recurrent primitive neuroectodermal tumors-medulloblastoma with lomustine, cisplatin and vincristine. Cancer 65: 412–417, 1990

    Google Scholar 

  29. Gentet JC, Doz F, Bouffet E, Plantaz D, Roche H, Tron P et al.: Carboplatin and VP-16 in medulloblastoma: A phase II study of the French Study of Pediatric Oncology (SFOP). Med and Ped Oncol 23: 422–427, 1994

    Google Scholar 

  30. Pendergrass TW, Milstein JM, Geyer JR et al.: Eight drugs in one day chemotherapy for brain tumors: Experience in 107 children and rationale for preradiation chemotherapy. J Clin Oncol 5: 1221–1231, 1987

    Google Scholar 

  31. Friedman HS, Krischer JP, Burger P, Oakes WJ, Hockenberger B, Weiner MD et al.: Treatment of children with progressive or recurrent brain tumors with carboplatin or iproplatin: A Pediatric Oncology Group Randomized phase II study. J Clin Oncol 10: 249–256, 1992

    Google Scholar 

  32. Gaynon PS, Ettinger LJ, Baum ES, Siegel SE, Krailo MD, Hammond GD: Carboplatin in childhood brain tumors. A Children's Cancer Study Group phase II trial. Cancer 66: 2465–2469, 1990

    Google Scholar 

  33. Finlay J, Garvin J, Allen J, Boyett J, Heller G, Yates A et al.: High-dose chemotherapy with autologous marrow rescue in patients with recurrent medulloblastoma/primitive neuroectodermal tumors. Proc Annu Meet Am Soc Clin Oncol 13: A493, 1994

    Google Scholar 

  34. van Eys J, Baram TZ, Cangir A, Bruner JM, Martinez-Prieto J: Salvage chemotherapy for tumors in children. J Peds 113: 601–606, 1988

    Google Scholar 

  35. Phillips PA: Antineoplastic drug resistance in brain tumors. Neurologic Clinics 9: 383–404, 1991

    Google Scholar 

  36. Tait DM, Thorton-Jones H, Bloom HJG, Lemerle J, Morris-Jones P: Adjuvant chemotherapy for medulloblastoma: The first multi-centre control trial of the International Society of Paediatric Oncology (SIOP I). Eur J Cancer 26: 464–469, 1990

    Google Scholar 

  37. Krischer JP, Ragab AH, Kun L, Kim TH, Laurel JP, Boyett JM et al.: Nitrogen mustard vincristine, procarbazine, and prednisone as adjuvant chemotherapy in the treatment of medulloblastoma. J Neurosurg 74: 905–909, 1991

    Google Scholar 

  38. Bloom HJG, Bessell EM: Medulloblastoma in adults: A review of 47 patients treated between 1951 and 1981. Int J Radiat Oncol Biol Phys 18: 763–772, 1990

    Google Scholar 

  39. van Eys J, Chen T, Moore T, Cheek W, Sexauer C, Starling K: Adjuvant chemotherapy for medulloblastoma and ependymoma using iv vincristine, intrathecal methotrexate, and intrathecal hydrocortisone: A Southwest Oncology Group study. Cancer Treat Rep 65: 681–684, 1981

    Google Scholar 

  40. Packer RJ, Sutton LN, Elterman R, Lange B, Goldwein J, Nicholson HS et al.: Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU and vincristine chemotherapy. J Neurosurg 81: 690–698, 1994

    Google Scholar 

  41. Packer RJ, Sutton LN, Goldwein JW, Perilongo G, Bunin G, Ryan JR et al.: Improved survival with the use of adjuvant chemotherapy in the treatment of medulloblastoma. J Neurosurg 74: 433–440, 1991

    Google Scholar 

  42. Goldwein JW, Radcliffe J, Packer RJ, Sutton LN, Lange B, Rorke LB, D'Angio GJ: Results of a pilot study of low-dose craniospinal radiation therapy plus chemotherapy for children younger than 5 years with primitive neuroectodermal tumors. Cancer 71: 2647–2652, 1993

    Google Scholar 

  43. Levin VA, Rodriguez LA, Edwards MSB, Wara W, Liu HC, Fulton D et al.: Treatment of medulloblatoma with procarbazine, hydroxyurea, and reduced radiation doses to whole brain and spine. J Neurosurg 68: 383–387, 1988

    Google Scholar 

  44. Kovnar EH, Kellie SJ, Horowitz ME, Sanford RA, Langston JW, Mulhern RK et al.: Preirradiation cisplatin and etoposide in the treatment of high-risk medulloblastoma and other malignant embryonal tumors of the central nervous system. A phase II study. J Clin Oncol 8: 330–336, 1990

    Google Scholar 

  45. Mosijczuk AD, Nigro MA, Thomas PRM, Burger PC, Krischer JP, Morantz RA et al.: Preradiation chemotherapy in advanced medulloblastoma. A Pediatric Oncology Group Pilot Study. Cancer 72: 2755–2762, 1993

    Google Scholar 

  46. Kretschmar CS, Tarbell NJ, Kupsky W, Lavally BL, Loeffler JS, Wolfe L et al.: Pre-irradiation chemotherapy for infants and children with medulloblastoma: A preliminary report. J Neurosurg 71: 820–825, 1989

    Google Scholar 

  47. Duffner PK, Horowitz ME, Krischer JP, Friedman HS, Burger PC, Cohen ME et al.: Postoperative chemotherapy and delayed radiation in children less than three years of age with malignant brain tumors. NEJM 328: 1725–1731, 1993

    Google Scholar 

  48. Geyer JR, Zeltzer PM, Boyett JM, Rorke LB, Stanley P, Albright AL et al.: Survival of infants with primitive neuroectodermal tumors or malignant ependymomas of the CNS treated with eight drugs in 1 day: A report from the Childrens Cancer Group. J Clin Oncol 12: 1607–1615, 1994

    Google Scholar 

  49. Finlay JL, Grovas A, Garvin J, Dunkel I, Bayer L, Pucceth D et al.: The ‘Head Start’ regimen for children less than six years of age newly-diagnosed with malignant brain tumors. Med Ped Oncol 25: 250, 1995

    Google Scholar 

  50. Olshan JS, Gubernick J, Packer RJ, D'Angio GJ, Goldwein JW, Willi SM, Moshang T: The effects of adjuvant chemotherapy on growth in children with medulloblastoma. Cancer 70: 2013–2017, 1992

    Google Scholar 

  51. Tomita T, McLone DG, Yasue M: Cerebral primitive neuroectodermal tumors in childhood. J Neuro-Oncol 6: 233–243, 1988

    Google Scholar 

  52. Ashwal S, Hinshaw DB, Bedros A: CNS primitive neuroectodermal tumors of childhood. Med Pediatr Oncol 12: 180–188, 1984

    Google Scholar 

  53. Zeltzer PM, Gaskill SJ, Marlin AE: Supratentorial primitive neuroectodermal tumors. In: Deutsch M (ed) Management of Childhood Brain Tumors. Boston, MA, Kluwer Academic Publishers, 1990

    Google Scholar 

  54. Jakacki RI, Zeltzer PM, Boyett JM, Albright AL, Allen JC, Geyer JR et al.: Survival and prognostic factors following radiation and/or chemotherapy for primitive neuroectodermal tumors of the pineal region in infants and children: A report of the Childrens Cancer Group. J Clin Oncol 13: 1377–1383, 1995

    Google Scholar 

  55. Bellani FF, Gasparini M, Lombardi F, Zucali R, Luccarelli G, Migliavacca F et al.: Medulloblastoma. Results of a sequential combined treatment. Cancer 54: 1956–1961, 1984

    Google Scholar 

  56. McIntosh S, Chen M, Sartain PA, Duncan C, Rishburn R, Klatskin EH et al.: Adjuvant chemotherapy for medulloblastoma. Cancer 56: 1316–1319, 1985

    Google Scholar 

  57. Allen JC, Walker R, Rosen G: Preirradiation high-dose intravenous methotrexate with leucovorin rescue for untreated primary childhood brain tumors. J Clin Oncol 6: 649–653, 1988

    Google Scholar 

  58. Bloom HJG, Glees J, Bell J: The treatment and long-term prognosis of children with intracranial tumors: A study of 610 cases, 1950–1981

Download references

Author information

Authors and Affiliations

  1. Department of Neurology, The Cleveland Clinic Foundation, Cleveland, Ohio

    Bruce H. Cohen

  2. Department of Neurology, Childrens National Medical Center, USA

    Roger J. Packer

  3. Department of Neurology and Pediatrics, The George Washington University, Washington, D. C., USA

    Roger J. Packer

Authors
  1. Bruce H. Cohen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roger J. Packer
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Cohen, B.H., Packer, R.J. Chemotherapy for medulloblastomas and primitive neuroectodermal tumors. J Neuro-Oncol 29, 55–68 (1996). https://doi.org/10.1007/BF00165518

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00165518

Key words

Search

Navigation