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Reducing the radiotherapy boost to the tumour bed instead of the whole posterior fossa was safe in average-risk medulloblastoma, but lowering the craniospinal dose from 23.4 to 18 Gy in young children led to more relapses, so the standard dose was kept.
Children's Oncology Group phase 3 trial of 464 children with average-risk medulloblastoma randomised to involved-field (tumour bed) versus whole posterior fossa boost, and, for children aged 3 to 7, to low-dose (18 Gy) versus standard-dose (23.4 Gy) craniospinal irradiation.
Five-year event-free survival was 82.5 percent with involved-field boost versus 80.5 percent with posterior fossa boost (non-inferior), but 71.4 percent with 18 Gy against 82.9 percent with 23.4 Gy craniospinal irradiation (inferior); WNT tumours did well regardless.
Tumour-bed boost is standard in average-risk medulloblastoma, while craniospinal dose reduction is reserved for the WNT-activated subgroup in trials.
Shares WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
Shares WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
Shares WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
Shares WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
Shares WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
Shares COG ACNS0331, WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
Shares WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).
Shares WNT-activated medulloblastoma, Group 3 and group 4 medulloblastoma (non-WNT/non-SHH).