ACNS0331: reduced-dose and reduced-volume radiotherapy with chemotherapy for average-risk medulloblastoma
Reducing the radiotherapy boost to the tumour bed instead of the whole posterior fossa was safe in average-risk medulloblastoma, but lowering the craniospinal dose from 23.4 to 18 Gy in young children led to more relapses, so the standard dose was kept.
Overview
Children's Oncology Group phase 3 trial of 464 children with average-risk medulloblastoma randomised to involved-field (tumour bed) versus whole posterior fossa boost, and, for children aged 3 to 7, to low-dose (18 Gy) versus standard-dose (23.4 Gy) craniospinal irradiation.
Five-year event-free survival was 82.5 percent with involved-field boost versus 80.5 percent with posterior fossa boost (non-inferior), but 71.4 percent with 18 Gy against 82.9 percent with 23.4 Gy craniospinal irradiation (inferior); WNT tumours did well regardless.
- Involved-field boost non-inferior: five-year event-free survival 82.5 percent vs 80.5 percent.
- 18 Gy craniospinal irradiation inferior: 71.4 percent vs 82.9 percent.
Tumour-bed boost is standard in average-risk medulloblastoma, while craniospinal dose reduction is reserved for the WNT-activated subgroup in trials.
- Molecular subgroup was determined retrospectively.
- Neurocognitive outcomes were somewhat better with lower dose, highlighting the trade-off.
Similar pages
not linked directly; found by shared links- Key paperMolecular subgroups of medulloblastoma: the current consensus
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- Key paperIntertumoural heterogeneity within medulloblastoma subgroups
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- Key paperThe 2021 WHO classification of tumours of the central nervous system: a summary
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- TermMedulloblastoma molecular groups (WNT, SHH, group 3, group 4)
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- TreatmentLomustine (CCNU)
Shares COG ACNS0331, WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
- TermLate effects and survivorship toxicity
Shares COG ACNS0331, WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
- InstitutionSt. Jude Children's Research Hospital
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- CancerSHH-activated medulloblastoma
Shares WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).