Journal Article

DKFZ-2020-00879

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Nonmetastatic Medulloblastoma of Early Childhood: Results From the Prospective Clinical Trial HIT-2000 and An Extended Validation Cohort.

Mynarek, M. ; von Hoff, K. ; Pietsch, T. ; Ottensmeier, H. ; Warmuth-Metz, M. ; Bison, B. ; Pfister, S.DKFZ* ; Korshunov, A.DKFZ* ; Sharma, T.DKFZ* ; Jaeger, N. ; Ryzhova, M. ; Zheludkova, O. ; Golanov, A. ; Rushing, E. J. ; Hasselblatt, M. ; Koch, A. ; Schüller, U. ; von Deimling, A.DKFZ* ; Sahm, F.DKFZ* ; Sill, M.DKFZ* ; Riemenschneider, M. J. ; Dohmen, H. ; Monoranu, C. M. ; Sommer, C. ; Staszewski, O. ; Mawrin, C. ; Schittenhelm, J. ; Brück, W. ; Filipski, K.DKFZ* ; Hartmann, C. ; Meinhardt, M. ; Pietschmann, K. ; Haberler, C. ; Slavc, I. ; Gerber, N. U. ; Grotzer, M. ; Benesch, M. ; Schlegel, P. G. ; Deinlein, F. ; von Bueren, A. O. ; Friedrich, C. ; Juhnke, B.-O. ; Obrecht, D. ; Fleischhack, G. ; Kwiecien, R. ; Faldum, A. ; Kortmann, R. D. ; Kool, M.DKFZ* ; Rutkowski, S.

2020
American Society of Clinical Oncology Alexandria, Va.

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Please use a persistent id in citations: doi:10.1200/JCO.19.03057

Abstract: The HIT-2000-BIS4 trial aimed to avoid highly detrimental craniospinal irradiation (CSI) in children < 4 years of age with nonmetastatic medulloblastoma by systemic chemotherapy, intraventricular methotrexate, and risk-adapted local radiotherapy.From 2001-2011, 87 patients received systemic chemotherapy and intraventricular methotrexate. Until 2006, CSI was reserved for nonresponse or progression. After 2006, local radiotherapy was introduced for nonresponders or patients with classic medulloblastoma (CMB) or large-cell/anaplastic medulloblastoma (LCA). DNA methylation profiles of infantile sonic hedgehog-activated medulloblastoma (SHH-INF) were subdivided into iSHH-I and iSHH-II subtypes in the HIT-2000-BIS4 cohort and a validation cohort (n = 71) from the HIT group and Russia.Five years after diagnosis, patients with desmoplastic medulloblastoma (DMB) or medulloblastoma with extensive nodularity (MBEN; n = 42) had 93% progression-free survival (5y-PFS), 100% overall survival (5y-OS), and 93% CSI-free (5y-CSI-free) survival. Patients with CMB/LCA (n = 45) had 37% 5y-PFS, 62% 5y-OS, and 39% 5y-CSI-free survival. Local radiotherapy did not improve survival in patients with CMB/LCA. All DMB/MBEN assessed by DNA methylation profiling belonged to the SHH-INF subgroup. Group 3 patients (5y-PFS, 36%; n = 14) relapsed more frequently than the SHH-INF group (5y-PFS, 93%; n = 28) or group 4 patients (5y-PFS, 83%; n = 6; P < .001). SHH-INF split into iSHH-I and iSHH-II subtypes in HIT-2000-BIS4 and the validation cohort, without prognostic impact (5y-PFS: iSHH-I, 73%, v iSHH-II, 83%; P = .25; n = 99). Intelligence quotient (IQ) was significantly lower in patients after CSI (mean IQ, 90 [no radiotherapy], v 74 [CSI]; P = .012).Systemic chemotherapy and intraventricular methotrexate led to favorable survival in both iSHH subtypes of SHH-activated DMB/MBEN with acceptable neurotoxicity. Survival in patients with non-wingless (WNT)/non-SHH disease with CMB/LCA was not improved by local radiotherapy. Patients with group 4 disease had more favorable survival rates than those with group 3 medulloblastoma.

Note: 2020 Jun 20;38(18):2028-2040

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Contributing Institute(s):

1. B062 Pädiatrische Neuroonkologie (B062)
2. KKE Neuropathologie (B300)
3. DKTK FM zentral (FM01)

Research Program(s):

1. 312 - Functional and structural genomics (POF3-312) (POF3-312)

Appears in the scientific report 2020

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Database coverage:
; Clarivate Analytics Master Journal List ; Current Contents - Clinical Medicine ; Current Contents - Life Sciences ; IF >= 25 ; JCR ; NCBI Molecular Biology Database ; Nationallizenz ; PubMed Central ; SCOPUS ; Science Citation Index ; Science Citation Index Expanded ; Web of Science Core Collection

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