Table 3 Main studies about the treatment of average risk medulloblastoma patients

Packer et al

reduced-dose craniospinal radiation therapy (23.4 Gy) and 55.8 Gy of local radiation therapy plus concomitant vincristine chemotherapy and adjuvant lomustine, vincristine, and cisplatin chemotherapy

PFS 86% ± 4% at 3 years and 79% ± 7% at 5 years

Padovani et al

radiotherapy vs radio + chemotherapy

standard-risk disease could be treated with radiochemotherapy, reducing doses of RT

Greenberg et al

radiotherapy + POG protocol/Packer protocol

adults on POG protocol seemed to have less nonhematologic toxicity; on the Packer protocol appeared to have shorter median survival and greater toxicity than did children

Friedrich et al

radiotherapy + chemotherapy with lomustine, vincristine and cisplatin

EFS4 and OS4 were 68% ± 7% and 89% ± 5%. Peripheral neuropathy (74%) and haematotoxicity (55%) during maintenance chemotherapy appear to be more common in adults than in children

Beier et al (NOA-07)

craniospinal irradiation with vincristine, followed by 8 cycles of cisplatin, lomustine, and vincristine

radio-polychemotherapy did lead to considerable toxicity and a high amount of dose reductions

Kortmann et al

ARM 1: neoadjuvant chemotherapy with ifosfamide, etoposide, intravenous high-dose methotrexate, cisplatin, and cytarabine before radiotherapy

ARM 2: immediate postoperative radiotherapy, with concomitant vincristine followed by 8 cycles of maintenance chemotherapy consisting of cisplatin, CCNU, and vincristine

maintenance chemotherapy would seem to be more effective in low-risk medulloblastoma Neoadjuvant chemotherapy was accompanied by increased myelotoxicity of the subsequent radiotherapy