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Volume 90 Number 3 2014

Radiation effects in medulloblastoma

protocol that limited prospective follow-up to 5 years and included patients with high-risk features. There are a number of clinical factors that strongly influence baseline and longi- tudinal cognition, including the effects of age (28) , tumor (hydrocephalus), and surgery (29, 30) . Accounting for these factors and the development of comprehensive parametric models, including dose, requires more patients. In summary, there are strong associations between ra- diation dose, irradiated volume, and cognitive outcomes as measured by standardized tests. When modeling the effect of radiation dose, clinical factors that affect baseline and longitudinal measures should be considered. Future research should be focused on assessing larger datasets, inclusion of patients treated with a wider range of CSI dose, and the development of multiparametric models. 1. Silverman CL, Palkes H, Talent B, et al. Late effects of radiotherapy on patients with cerebellar medulloblastoma. Cancer 1984;54:825-829 . 2. LeBaron S, Zeltzer PM, Zeltzer LK, et al. Assessment of quality of survival in children with medulloblastoma and cerebellar astrocytoma. Cancer 1988;62:1215-1222 . 3. Hoppe-Hirsch E, Renier D, Lellouch-Tubiana A, et al. Medulloblas- toma in childhood: Progressive intellectual deterioration. Childs Nerv Syst 1990;6:60-65 . 4. Kao GD, Goldwein JW, Schultz DJ, et al. The impact of perioperative factors on subsequent intelligence quotient deficits in children treated for medulloblastoma/posterior fossa primitive neuroectodermal tu- mors. Cancer 1994;74:965-971 . 5. Radcliffe J, Bunin GR, Sutton LN, et al. Cognitive deficits in long- term survivors of childhood medulloblastoma and other noncortical tumors: Age-dependent effects of whole brain radiation. Int J Dev Neurosci 1994;12:327-334 . 6. Packer RJ, Goldwein J, Nicholson HS, et al. Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy: A Children’s Cancer Group Study. J Clin Oncol 1999;17:2127-2136 . 7. Merchant TE, Kun LE, Krasin MJ, et al. Multi-institution prospective trial of reduced-dose craniospinal radiation (23.4 Gy) followed by conformal posterior fossa (36 Gy) and primary site irradiation (55.8 Gy) and dose-intensitive chemotherapy for average-risk medullo- blastoma. Int J Radiat Oncol Biol Phys 2008;70:782-787 . 8. Gajjar A. A Clinical and Molecular Risk-Directed Therapy for Newly Diagnosed Medulloblastoma. NCT01878617 (SJMB03). ClinicalTrial s.gov 2013. Available from: URL: http://clinicaltrials.gov/ct2/show/ NCT01878617?term Z sjmb03&rank Z 1 . Accessed July 24, 2014. 9. Michalski J. A study evaluating limited target volume boost irradiation and reduced dose craniospinal radiotherapy (18.00 Gy) and chemotherapy in children with newly diagnosed standard risk me- dulloblastoma: A phase III double randomized Trial. ClinicalTrials. gov identifier NCT00085735 (ACNS0331). Available at: http:// clinicaltrials.gov/ct2/show/NCT00085735?term Z acns0331&rank Z 1 . 10. Ris MD, Packer R, Goldwein J, et al. Intellectual outcome after reduced-dose radiation therapy plus adjuvant chemotherapy for me- dulloblastoma: A Children’s Cancer Group study. J Clin Oncol 2001; 19:3470-3476 . References

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