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PURPOSE: To compare quality of survival in "standard-risk" medulloblastoma after hyperfractionated radiation therapy of the central nervous system with that after standard radiation therapy, combined with a chemotherapy regimen common to both treatment arms, in the PNET4 randomised controlled trial. METHODS AND MATERIALS: Participants in the PNET4 trial and their parents/caregivers in 7 participating anonymized countries completed standardized questionnaires in their own language on executive function, health status, behavior, health-related quality of life, and medical, educational, employment, and social information. Pre- and postoperative neurologic status and serial heights and weights were also recorded. RESULTS: Data were provided by 151 of 244 eligible survivors (62%) at a median age at assessment of 15.2 years and median interval from diagnosis of 5.8 years. Compared with standard radiation therapy, hyperfractionated radiation therapy was associated with lower (ie, better) z-scores for executive function in all participants (mean intergroup difference 0.48 SDs, 95% confidence interval 0.16-0.81, P=.004), but health status, behavioral difficulties, and health-related quality of life z-scores were similar in the 2 treatment arms. Data on hearing impairment were equivocal. Hyperfractionated radiation therapy was also associated with greater decrement in height z-scores (mean intergroup difference 0.43 SDs, 95% confidence interval 0.10-0.76, P=.011). CONCLUSIONS: Hyperfractionated radiation therapy was associated with better executive function and worse growth but without accompanying change in health status, behavior, or quality of life.

Original publication

DOI

10.1016/j.ijrobp.2013.09.046

Type

Journal article

Journal

International journal of radiation oncology, biology, physics

Publication Date

02/2014

Volume

88

Pages

292 - 300

Addresses

University of Southampton Faculty of Medicine and University Hospital Southampton National Health Service Foundation Trust, Southampton, United Kingdom. Electronic address: crk1@soton.ac.uk.

Keywords

PNET4 study group of the Brain Tumour Group of The European branch of the International Society of Paediatric Oncology (SIOP-E), Humans, Medulloblastoma, Cerebellar Neoplasms, Antineoplastic Combined Chemotherapy Protocols, Combined Modality Therapy, Hormone Replacement Therapy, Dose Fractionation, Questionnaires, Follow-Up Studies, Behavior, Hearing, Age Factors, Health Status, Growth, Quality of Life, Adolescent, Child, Child, Preschool, Survivors, Employment, Outcome Assessment (Health Care), Europe, Female, Male, Young Adult, Executive Function