TY  - JOUR
A1  - Gaab, Christine
A1  - Adolph, Jonas E.
A1  - Tippelt, Stephan
A1  - Mikasch, Ruth
A1  - Obrecht, Denise
A1  - Mynarek, Martin
A1  - Rutkowski, Stefan
A1  - Pfister, Stefan M.
A1  - Milde, Till
A1  - Witt, Olaf
A1  - Bison, Brigitte
A1  - Warmuth-Metz, Monika
A1  - Kortmann, Rolf-Dieter
A1  - Dietzsch, Stefan
A1  - Pietsch, Torsten
A1  - Timmermann, Beate
A1  - Sträter, Ronald
A1  - Bode, Udo
A1  - Faldum, Andreas
A1  - Kwiecien, Robert
A1  - Fleischhack, Gudrun
T1  - Local and systemic therapy of recurrent medulloblastomas in children and adolescents: results of the P-HIT-REZ 2005 Study
JF  - Cancers
N2  - Recurrent medulloblastomas are associated with survival rates <10%. Adequate multimodal therapy is being discussed as having a major impact on survival. In this study, 93 patients with recurrent medulloblastoma treated in the German P-HIT-REZ 2005 Study were analyzed for survival (PFS, OS) dependent on patient, disease, and treatment characteristics. The median age at the first recurrence was 10.1 years (IQR: 6.9–16.1). Median PFS and OS, at first recurrence, were 7.9 months (CI: 5.7–10.0) and 18.5 months (CI: 13.6–23.5), respectively. Early relapses/progressions (<18 months, n = 30/93) found mainly in molecular subgroup 3 were associated with markedly worse median PFS (HR: 2.34) and OS (HR: 3.26) in regression analyses. A significant survival advantage was found for the use of volume-reducing surgery as well as radiotherapy. Intravenous chemotherapy with carboplatin and etoposide (ivCHT, n = 28/93) showed improved PFS and OS data and the best objective response rate (ORR) was 66.7% compared to oral temozolomide (oCHT, n = 47/93) which was 34.8%. Intraventricular (n = 43) as well as high-dose chemotherapy (n = 17) at first relapse was not related to a significant survival benefit. Although the results are limited due to a non-randomized study design, they may serve as a basis for future treatment decisions in order to improve the patients' survival.
KW  - medulloblastoma
KW  - refractory
KW  - recurrent
KW  - children
KW  - chemotherapy
KW  - surgery
KW  - radiotherapy
KW  - re-irradiation
KW  - intraventricular therapy
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-254809
SN  - 2072-6694
VL  - 14
IS  - 3
ER  - 
TY  - JOUR
A1  - Kandels, Daniela
A1  - Pietsch, Torsten
A1  - Bison, Brigitte
A1  - Warmuth‐Metz, Monika
A1  - Thomale, Ulrich‐Wilhelm
A1  - Kortmann, Rolf‐Dieter
A1  - Timmermann, Beate
A1  - Hernáiz Driever, Pablo
A1  - Witt, Olaf
A1  - Schmidt, René
A1  - Gnekow, Astrid K.
T1  - Loss of efficacy of subsequent nonsurgical therapy after primary treatment failure in pediatric low‐grade glioma patients—Report from the German SIOP‐LGG 2004 cohort
JF  - International Journal of Cancer
N2  - First‐line treatment of pediatric low‐grade glioma using surgery, radio‐ or chemotherapy fails in a relevant proportion of patients. We analyzed efficacy of subsequent surgical and nonsurgical therapies of the German cohort of the SIOP‐LGG 2004 study (2004‐2012, 1558 registered patients; median age at diagnosis 7.6 years, median observation time 9.2 years, overall survival 98%/96% at 5/10 years, 15% neurofibromatosis type 1 [NF1]). During follow‐up, 1078/1558 patients remained observed without (n = 217), with 1 (n = 707), 2 (n = 124) or 3 to 6 (n = 30) tumor volume reductions; 480/1558 had 1 (n = 332), 2 (n = 80), 3 or more (n = 68) nonsurgical treatment‐lines, accompanied by up to 4 tumor‐reductive surgeries in 215/480; 265/480 patients never underwent any neurosurgical tumor volume reduction (163/265 optic pathway glioma). Patients with progressing tumors after first‐line adjuvant treatment were at increased risk of suffering further progressions. Risk factors were young age (<1 year) at start of treatment, tumor dissemination or progression within 18 months after start of chemotherapy. Progression‐free survival rates declined with subsequent treatment‐lines, yet remaining higher for patients with NF1. In non‐NF1‐associated tumors, vinblastine monotherapy vs platinum‐based chemotherapy was noticeably less effective when used as second‐line treatment. Yet, for the entire cohort, results did not favor a certain sequence of specific treatment options. Rather, all can be aligned as a portfolio of choices which need careful balancing of risks and benefits. Future molecular data may predict long‐term tumor biology.
KW  - chemotherapy
KW  - pediatric low‐grade glioma
KW  - progression
KW  - radiotherapy
KW  - surgery
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-216130
VL  - 147
IS  - 12
SP  - 3471
EP  - 3489
ER  -