{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T13:06:03Z","timestamp":1779541563834,"version":"3.53.1"},"reference-count":24,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp;amp; Cancer"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Group 4 medulloblastoma (MB) is rare in young children. Data on craniospinal irradiation (CSI)\u2010sparing approaches are limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This multicenter study reported outcomes for patients younger than 7\u00a0years old with Group 4 MB treated with high\u2010dose chemotherapy (HDC) without adjuvant CSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Thirty\u2010eight patients were included (26 M\/12 F). Median age at diagnosis was 46.4\u00a0months (25.9\u201378), with 24% \u226436\u00a0months. Twenty\u2010four patients (63.2%) had localized disease. Fourteen (36.8%) presented with metastatic disease, and 26 (68.4%) underwent gross total resection (GTR). The most used HDC regimens were carboplatin\/thiotepa (76.3%) and carboplatin\/thiotepa\/etoposide (21.1%). Twenty (52.6%) relapses occurred at a median 21.9\u00a0months (5\u201399.8) from diagnosis. Patients with upfront GTR and\/or who received three cycles of HDC had better PFS (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.02 and\n                      <jats:italic>p<\/jats:italic>\n                      = 0.002, respectively). Local relapse accounted for 45%. Eighteen patients received salvage therapy with curative intent, all with radiotherapy (16 = CSI, 2 = focal). The CSI dose ranged from 18 to 36\u00a0Gy, and 43.7% received \u226423.4\u00a0Gy. Patients who underwent salvage surgery and\/or chemotherapy were more likely to receive CSI \u226423.4\u00a0Gy (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.008 and\n                      <jats:italic>p<\/jats:italic>\n                      = 0.03). The 5\u2010year post\u2010relapse survival and overall survival (OS) were, respectively, 60.3% (95% confidence interval [CI]: 26.9\u201382) and 72.7% (95% CI: 51.9\u201385.7). The 5\u2010year CSI\u2010free OS was 69.7% (95% CI: 39.1\u201387.1).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High dose chemotherapy for Group 4 MB was associated with a relapse rate of 52.6%, which favorably compares to data reported with conventional chemotherapy. Salvage radiotherapy retrieved more than two\u2010thirds of the patients. Half of the survivors never received radiotherapy. Such an approach may represent an alternative to upfront CSI for young children with Group 4 MB.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70181","type":"journal-article","created":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T10:57:26Z","timestamp":1773399446000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Group 4 Medulloblastomas of Early Childhood Treated With High\u2010Dose Chemotherapy\u2010 and Craniospinal Irradiation\u2010Sparing Approach"],"prefix":"10.1002","volume":"73","author":[{"given":"Patricia","family":"Ordu\u00f1a","sequence":"first","affiliation":[{"name":"Section of Pediatric Hematology and Bone Marrow Transplantation Alberta Children's Hospital  Calgary Alberta Canada"},{"name":"Division of Pediatric Neurology University of the Philippines \u2013 Philippine General Hospital  Manila Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rose Daynielle","family":"Cansanay","sequence":"additional","affiliation":[{"name":"Section of Pediatric Hematology and Bone Marrow Transplantation Alberta Children's Hospital  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1394-7167","authenticated-orcid":false,"given":"Craig","family":"Erker","sequence":"additional","affiliation":[{"name":"Division of Hematology\/Oncology, Department of Pediatrics IWK Health Centre and Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin","family":"Ratterman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Oncology Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary Pat","family":"Schlosser","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Stollery Children's Hospital University of Alberta  Edmonton Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca","family":"Ronsley","sequence":"additional","affiliation":[{"name":"Division of Pediatric Oncology Seattle Children's Hospital  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chantel","family":"Cacciotti","sequence":"additional","affiliation":[{"name":"Department of Pediatrics McMaster University, London Health Sciences  London Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sylvia","family":"Cheng","sequence":"additional","affiliation":[{"name":"Division of Hematology, Oncology\/Bone Marrow Transplant, Department of Pediatrics, British Columbia Children's Hospital and University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliette","family":"Hukin","sequence":"additional","affiliation":[{"name":"Divisions of Neurology and Hematology, Oncology\/Bone Marrow Transplant, Department of Pediatrics British Columbia Children's Hospital and University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolly","family":"Aguilera","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta &amp; Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Mazewski","sequence":"additional","affiliation":[{"name":"Children's Healthcare of Atlanta &amp; Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2015-0615","authenticated-orcid":false,"given":"Vanan","family":"Magimairajan","sequence":"additional","affiliation":[{"name":"Cancer Care Manitoba Research Institute  Winnipeg Manitoba Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natasha","family":"Pillay\u2010Smiley","sequence":"additional","affiliation":[{"name":"Cancer and Blood Diseases Institute Cincinnati Children's Hospital Medical Center  Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer Farouk","family":"Sait","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Memorial Sloan Kettering Cancer Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Cluster","sequence":"additional","affiliation":[{"name":"The Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, St. Louis Children's Hospital Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed S.","family":"Abdelbaki","sequence":"additional","affiliation":[{"name":"The Division of Pediatric Hematology, Oncology and Bone Marrow Transplant, St. Louis Children's Hospital Washington University School of Medicine  St. Louis Missouri USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley S.","family":"Margol","sequence":"additional","affiliation":[{"name":"Cancer and Blood Disease Institute, Children's Hospital Los Angeles Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Michaiel","sequence":"additional","affiliation":[{"name":"Divisions of Hematology Oncology\/Bone Marrow Transplant Department of Pediatrics British Columbia Children's Hospital and University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan","family":"Chi","sequence":"additional","affiliation":[{"name":"Dana Farber\/Boston Children's Cancer and Blood Disorder Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Salloum","sequence":"additional","affiliation":[{"name":"Dana Farber\/Boston Children's Cancer and Blood Disorder Center  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Harrod","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology Oncology Dell Children's Medical Center  Austin Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lindsey","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Center For Cancer and Blood Disorders Phoenix Children's Hospital  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalise","family":"Bracher","sequence":"additional","affiliation":[{"name":"Center For Cancer and Blood Disorders Phoenix Children's Hospital  Phoenix Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akanksha","family":"Senapati","sequence":"additional","affiliation":[{"name":"Division of Pediatric Hematology Oncology Manchester University NHS Foundation Trust  Manchester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vijay","family":"Ramaswamy","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology, Department of Paediatrics The Hospital for Sick Children and University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michal","family":"Zapotocky","sequence":"additional","affiliation":[{"name":"Department of Paediatric Haematology and Oncology, Faculty of Medicine Charles University and University Hospital Motol  Prague Czech Republic"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8450-0480","authenticated-orcid":false,"given":"Vicente Santa\u2010Maria","family":"Lopez","sequence":"additional","affiliation":[{"name":"Department of Paediatric Oncology Hospital Sant Joan De Deu  Barcelona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Doris","sequence":"additional","affiliation":[{"name":"Children's Hospital of Colorado &amp; University of Colorado School of Medicine  Denver Colorado USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Mynarek","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5446-9571","authenticated-orcid":false,"given":"Stefan","family":"Rutkowski","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology University Medical Center Hamburg\u2010Eppendorf  Hamburg Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Lassaletta","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology and Oncology Hospital Infantil Universitario Ni\u00f1o Jes\u00fas  Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6832-6539","authenticated-orcid":false,"given":"Eric","family":"Bouffet","sequence":"additional","affiliation":[{"name":"Division of Haematology\/Oncology, Department of Paediatrics The Hospital for Sick Children and University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4569-3499","authenticated-orcid":false,"given":"Lucie","family":"Lafay\u2010Cousin","sequence":"additional","affiliation":[{"name":"Section of Pediatric Hematology and Bone Marrow Transplantation Alberta Children's Hospital  Calgary Alberta Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,13]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-014-1588-x"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-017-2468-y"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/nan.12656"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(20011215)92:12<3155::AID-CNCR10158>3.0.CO;2-C"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.03057"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(18)30204-3"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noaf132"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21525"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noaa102"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2011.39.1110"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2015.03.019"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2023.4437"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-012-0958-8"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noae064.531"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.21.02968"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.01359"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(20)30246-7"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/noab293"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.20.02730"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.00.5355"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.26042"},{"key":"e_1_2_9_23_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.00.5355"},{"key":"e_1_2_9_24_1","unstructured":"Children's Oncology Group \u201cA Study of Treatment for Medulloblastoma Using Sodium Thiosulfate to Reduce Hearing Loss [NCT05382338] \u201dChildren's Oncology Group last updated December 22 2025 https:\/\/clinicaltrials.gov\/study\/NCT05382338."},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00401-023-02566-0"}],"container-title":["Pediatric Blood &amp; Cancer"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70181","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/1545-5017.70181","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/1545-5017.70181","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T12:27:41Z","timestamp":1779539261000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/1545-5017.70181"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,13]]},"references-count":24,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,5]]}},"alternative-id":["10.1002\/1545-5017.70181"],"URL":"https:\/\/doi.org\/10.1002\/1545-5017.70181","archive":["Portico"],"relation":{},"ISSN":["1545-5009","1545-5017"],"issn-type":[{"value":"1545-5009","type":"print"},{"value":"1545-5017","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,13]]},"assertion":[{"value":"2025-12-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-01-22","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-03-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70181"}}