{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T02:13:31Z","timestamp":1787278411545,"version":"build-2736575974"},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T00:00:00Z","timestamp":1584489600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000902","name":"Pediatric Cancer Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000902","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>We report the outcomes of patients with pineoblastoma and trilateral retinoblastoma syndrome enrolled on the Head Start (HS) I\u2010III trials.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Twenty\u2010three children were enrolled prospectively between 1991 and 2009. Treatment included maximal surgical resection followed by five cycles of intensive chemotherapy and consolidation with marrow\u2010ablative chemotherapy and autologous hematopoietic cell rescue (HDCx\/AuHCR). Irradiation following consolidation was reserved for children over six years of age or those with residual tumor at the end of induction.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Median age was 3.12 years (range, 0.44\u20105.72). Three patients withdrew from the study treatment and two patients experienced chemotherapy\u2010related death. Eight patients experienced progressive disease (PD) during induction chemotherapy and did not proceed to HDCx\/AuHCR. Ten patients received HDCx\/AuHCR; eight experienced PD post\u2010consolidation. Seven patients received craniospinal irradiation (CSI) with a median dose of 20.7\u00a0Gy (range, 18\u201036\u00a0Gy) with boost(s) (median dose 27\u00a0Gy; range, 18\u201036\u00a0Gy); three received CSI as adjuvant therapy (two post\u2010HDCx\/AuHCR) and four upon progression\/recurrence. The five\u2010year progression\u2010free survival (PFS) and overall survival (OS) were 9.7% (95% confidence intervals [CI]: 2.6%\u201036.0%) and 13% (95% CI: 4.5%\u201037.5%), respectively. Only three patients survived beyond five years. Favorable OS prognostic factors were CSI (hazard ratio [HR]\u00a0=\u00a00.30 [0.11\u20100.86], <jats:italic>P<\/jats:italic>\u00a0=\u00a00.025) and HDCx\/AuHCR (HR\u00a0=\u00a00.40 [0.16\u20100.99], <jats:italic>P<\/jats:italic>\u00a0=\u00a00.047).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Within the HS I\u2010III trials, CSI and HDCx\/AuHCR were statistically associated with improved survival. The high PD rate during later induction cycles and following consolidation chemotherapy warrants consideration of fewer induction cycles prior to consolidation and the potential intensification of consolidation with multiple cycles of marrow\u2010ablative chemotherapy and irradiation.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pbc.28252","type":"journal-article","created":{"date-parts":[[2020,3,18]],"date-time":"2020-03-18T20:49:28Z","timestamp":1584564568000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Pineoblastoma in children less than six years of age: The Head Start I, II, and III experience"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8262-7469","authenticated-orcid":false,"given":"Mohamed S.","family":"Abdelbaki","sequence":"first","affiliation":[{"name":"The Division of Hematology, Oncology and Blood and Marrow Transplant Nationwide Children's Hospital and The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4606-2269","authenticated-orcid":false,"given":"Mohammad H.","family":"Abu\u2010Arja","sequence":"additional","affiliation":[{"name":"The Department of Pediatrics, New York\u2010Presbyterian Brooklyn Methodist Hospital Weill\u2010Cornell College of Medicine  Brooklyn New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom B.","family":"Davidson","sequence":"additional","affiliation":[{"name":"The Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Center for Cancer and Blood Diseases Children's Hospital Los Angeles  Los Angeles California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason R.","family":"Fangusaro","sequence":"additional","affiliation":[{"name":"The Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta Emory University School of Medicine  Atlanta Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph R.","family":"Stanek","sequence":"additional","affiliation":[{"name":"The Division of Hematology, Oncology and Blood and Marrow Transplant Nationwide Children's Hospital and The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ira J.","family":"Dunkel","sequence":"additional","affiliation":[{"name":"The Department of Pediatrics Memorial Sloan Kettering Cancer Center  New York New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Girish","family":"Dhall","sequence":"additional","affiliation":[{"name":"The Division of Pediatric Hematology Oncology and Bone Marrow Transplantation at the University of Alabama at Birmingham Birmingham  Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon L.","family":"Gardner","sequence":"additional","affiliation":[{"name":"The Stephen D. Hassenfeld Children's Center for Cancer and Blood Disorders New York University  New York City New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan L.","family":"Finlay","sequence":"additional","affiliation":[{"name":"The Division of Hematology, Oncology and Blood and Marrow Transplant Nationwide Children's Hospital and The Ohio State University  Columbus Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,3,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nox158"},{"key":"e_1_2_10_3_1","volume-title":"WHO Classification of Tumours of the Central Nervous System","author":"Louis DN","year":"2007"},{"issue":"4","key":"e_1_2_10_4_1","first-page":"576","article-title":"Evaluation of age\u2010dependent treatment strategies for children and young adults with pineoblastoma: analysis of pooled European Society for Paediatric Oncology (SIOP\u2010E) and US Head Start data","volume":"19","author":"Mynarek M","year":"2017","journal-title":"Neuro Oncol"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.26300"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199301143280203"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3171\/jns.1989.70.5.0707"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21307"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1148\/93.6.1351"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25436"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-013-1111-9"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.12.126"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.21578"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1053-4296(03)00031-6"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1159\/000121138"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(19990701)86:1<135::AID-CNCR19>3.0.CO;2-0"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1995.13.6.1377"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/mpo.2950250109"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-006-9221-2"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuonc\/nos292"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.09.095"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.wneu.2018.07.079"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2014.04.017"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1215\/15228517-2008-079"},{"issue":"2","key":"e_1_2_10_25_1","first-page":"i71","article-title":"Favorable outcomes in children with pineoblastoma treated with risk\u2010adapted craniospinal irradiation and chemotherapy: results and molecular analysis from the SJYC07 and SJMB03 trials [abstract]","volume":"20","author":"Liu APY","year":"2018","journal-title":"Neuro Oncol"},{"key":"e_1_2_10_26_1","first-page":"JCO2017764720","article-title":"Extensive molecular and clinical heterogeneity in patients with histologically diagnosed CNS\u2010PNET treated as a single entity: a report from the Children's Oncology Group Randomized ACNS0332 Trial","author":"Hwang EI","year":"2018","journal-title":"J Clin Oncol"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2003.10.096"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.09.026"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejca.2006.01.039"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/neuros\/nyx005"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/pbc.25405"}],"container-title":["Pediatric Blood &amp; 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