Feasibility Of Four Consecutive High-Dose Chemotherapy Cycles With Stem-Cell Rescue For Patients With Newly Diagnosed Medulloblastoma Or Supratentorial Primitive Neuroectodermal Tumor After Craniospinal Radiotherapy: Results Of A Collaborative Study

Purpose: This study was designed to determine the feasibility and safety of delivering four consecutive cycles of high-dose cyclophosphamide, cisplatin, and vincristine, each followed by stem-cell rescue, every 4 weeks, after completion of risk-adapted craniospinal irradiation to children with newly diagnosed medulloblastama or supratentorial primitive neuroectodermal tumor (PNET).Patients and Methods: Fifty-three patients, 19 with high-risk disease and 34 with average-risk disease, were enrolled onto this study. After surgical resection, high-risk patients were treated with topotecan in a 6-week phase II window followed by craniospinal radiation therapy and four cycles of high-dose cyclophosphamide (4,000 mg/m(2) per cycle), with cisplatin (75 mg/m(2) per cycle), and vincristine (two 1.5-mg/m(2) doses per cycle). Support with peripheral blood stem cells or bone marrow and with granulocyte colony-stimulating factor was administered after each cycle of high-dose chemotherapy. Treatment of average-risk patients consisted of surgical resection and craniospinal irradiatian, followed by the same chemotherapy given to patients with high-risk disease. The expected duration of the chemotherapy was 16 weeks, with a cumulative cyclophosphamide dose of 16,000 mg/m(2) and a planned dose-intensity of 1,000 mg/m(2)/wk.Results: Fifty of the 53 patients commenced high-dose chemotherapy, and 49 patients completed all four cycles. The median length of chemotherapy cycles one through four was 28, 27, 29, and 28 days, respectively. Engraftment occurred at a median of 14 to 15 days after infusion of stem cells or autologous bone marrow. The intended dose-intensity of cyclophosphamide was 1,000 mg/m(2)/wk; the median delivered dose-intensity was 1,014, 1,023, 974, and 991 mg/m(2)/wk for cycles 1 through 4, respectively; associated median relative dose-intensity was 101%, 102%, 97%, and 99%. No deaths were attributable to the toxic effects of high-dose chemotherapy. Early outcome analysis indicates a 5-year progression-free survival of 93.6% + 4.7% for the average-risk patients. For the high-risk patients, the 2-year progression-free survival is 73.7% + 10.5% from the start of therapy and 84.2% + 8.6% from the start of radiation therapy.Conclusion: administering four consecutive cycles of high-dose chemotherapy with stem-cell support after surgical resection and craniospinal irradiation is feasible in newly diagnosed patients with medulloblastoma/supra-tentorial PNET with aggressive supportive care. The early outcome results of this approach are very encouraging. (C) 2001 by American Society of Clinical Oncology.