Journal
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS
Volume 88, Issue 2, Pages 292-300Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.ijrobp.2013.09.046
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Funding
- The Brain Tumour Charity, the Children's Cancer and Leukaemia Group
- Piam Brown Charitable Fund Southampton
- German Ministry of Health and Education [BMBF 01GI9958/5]
- The European Union's Seventh Framework Programme [FP72007-2013, 261743]
- German Children's Cancer Foundation (Deutsche Kinderkrebsstiftung), the French Ministry of Health
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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, PZ=.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. (C) 2014 Elsevier Inc.
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