Hyperfractionated Accelerated Radiotherapy in the Milan Strategy for Metastatic Medulloblastoma

Purpose With a view to improving the prognosis for patients with metastatic medulloblastoma, we tested the efficacy and toxicity of a hyperfractionated accelerated radiotherapy (HART) regimen delivered after intensive sequential chemotherapy. Patients and Methods Between 1998 and 2007, 33 consecutive patients received postoperative methotrexate (8 g/m2), etoposide (2.4 g/m2), cyclophosphamide (4 g/m2), and carboplatin (0.8 g/m2) in a 2-month schedule, then HART with a maximal dose to the neuraxis of 39 Gy (1.3 Gy/fraction, 2 fractions/d) and a posterior fossa boost up to 60 Gy (1.5 Gy/fraction,2 fractions/d). Patients with persistent disseminated disease before HART were consolidated with two myeloablative courses and circulating progenitor cell rescue. Results Patients were classified as having M1 (n = 9), M2 (n = 6), M3 (n = 17), and M4 (n = 1) disease. Seven patients younger than 10 years old who achieved complete response after chemotherapy received a lower dose to the neuraxis (31.2 Gy). Twenty-two o...