Outcome and prognostic factors for children with supratentorial primitive neuroectodermal tumors treated with carboplatin during radiotherapy: A report from the Children's Oncology Group |
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Authors: | Regina I Jakacki MD Peter C Burger MD Mehmet Kocak PhD James M Boyett PhD Joel Goldwein MD Minesh Mehta MB eChB Roger J Packer MD Nancy J Tarbell MD Ian F Pollack MD |
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Institution: | 1. AstraZeneca, One Medimmune Way, Gaithersburg, Maryland;2. Department of Pathology, Baltimore, Maryland;3. Department of Preventive Medicine, University of Tennessee, Memphis, Tennessee;4. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee;5. Department of Radiation Oncology, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania;6. University of Maryland School of Medicine, Baltimore, Maryland;7. Children's National Medical Center, Washington, District of Columbia;8. Harvard Medical School, Boston, Massachusetts;9. Department of Neurological Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania |
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Abstract: | Background Supratentorial PNETs (sPNET) are uncommon embryonal malignancies of the central nervous system whose prognosis has historically been poor. We evaluated the outcome and prognostic factors of children with sPNET treated prospectively on a Children's Oncology Group trial. Procedure Following surgery, patients received craniospinal radiotherapy with concurrent carboplatin followed by six months of maintenance chemotherapy with cyclophosphamide and vincristine. Results Five‐year overall survival (OS) and progression‐free survival (PFS) for all patients was 58 ± 7% and 48 ± 7%. For patients with pineoblastoma (n = 23), five‐year OS and PFS was 81 ± 9% and 62 ± 11%. Extent of resection but not M‐stage was prognostic. Five‐year OS and PFS for 37 patients with non‐pineal tumors (NPsPNET) was 44 ± 8% and 39 ± 8%, significantly worse than for PB (P = 0.055 and 0.009 respectively). Extent of resection and major radiotherapy deviations were prognostic. Five year OS was 59 +/? 11.4% for those undergoing complete resection versus 10.4 +/? 7% for those who did not (P = 0.017). Central pathologic review called 14 (38%) “classic” sPNET, 8 (22%) “undifferentiated” and 13 (35%) “malignant gliomas.” There was no significant difference between the subgroups, although survival distributions approached significance when the combined “classic” and “undifferentiated” group was compared to the “malignant gliomas.” Conclusions Carboplatin during RT followed by 6 months of non‐intensive chemotherapy is a feasible treatment strategy for patients with sPNET. Aggressive surgical resection should be attempted if feasible. The classification of supratentorial small cell malignancies can be difficult. Pediatr Blood Cancer 2015;62:776–783. © 2015 Wiley Periodicals, Inc. |
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Keywords: | supratentorial PNET brain tumor radiosensitizer prognostic factors pineoblastoma pediatrics |
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