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Cisplatin-based regimens for standard-risk (SR) MB are effective but associated with significant toxicities, particularly ototoxicity. This study compares the toxicity profiles of two CT regimens, focusing on grade\u2009\u2265\u20093 ototoxicity, hematologic, hepatic, renal, and neurologic toxicities.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This study included SR-MB patients aged 3\u201318 years. Cohort A (2016\u20132019) received adjuvant CT adopted from the Children\u2019s Oncology Group (COG) A9961 Regimen A protocol, with data collected retrospectively. Cohort B (2020\u2013July 2022) received CT adopted from the ACNS0331 protocol, with data collected prospectively. Toxicities were assessed and graded using the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 168 patients aged 3 to 18 years were enrolled, 112 (67%) in cohort A and 56 (33%) in cohort B. Grade\u2009\u2265\u20093 ototoxicity was significantly higher in cohort A (24% vs. 3.6%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Neurotoxicity occurred in 26% vs. 12.5% (<jats:italic>p<\/jats:italic>\u2009=\u20090.046). Anemia and thrombocytopenia in 71% vs. 52% (<jats:italic>p<\/jats:italic>\u2009=\u20090.04). Febrile neutropenia was more common in cohort B (66% vs. 38%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). No significant differences were found in grade\u2009\u2265\u20093 leukopenia, nephrotoxicity or hepatotoxicity. The 2-year overall survival was 96.4% (95% CI: 93.1\u201399.9) in cohort A vs. 86.6% (95% CI: 77.8\u201396.4) in cohort B (<jats:italic>p<\/jats:italic>\u2009=\u20090.11). Event-free survival was 92.9% (95% CI: 88.2\u201397.8) vs. 86.8% (95% CI: 78-96.4) (<jats:italic>p<\/jats:italic>\u2009=\u20090.29).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Partial substitution of cisplatin with cyclophosphamide showed a better toxicity profile, particularly for ototoxicity and neurotoxicity, with no significant difference in survival.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s11060-025-05098-7","type":"journal-article","created":{"date-parts":[[2025,6,10]],"date-time":"2025-06-10T12:50:55Z","timestamp":1749559855000},"page":"689-697","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of partial substitution of cisplatin with cyclophosphamide on acute toxicities in standard-risk medulloblastoma"],"prefix":"10.1007","volume":"174","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9803-7957","authenticated-orcid":false,"given":"Sarah Magdy","family":"Metwally","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9791-0104","authenticated-orcid":false,"given":"Moatasem","family":"El-Ayadi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5428-1555","authenticated-orcid":false,"given":"Eslam","family":"Maher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mohamed Sherif","family":"El-Minawi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1999-6528","authenticated-orcid":false,"given":"Mohamed S.","family":"Zaghloul","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hala","family":"Taha","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sherif","family":"Aboulnaga","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5105-3140","authenticated-orcid":false,"given":"Iman","family":"Sidhom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,6,10]]},"reference":[{"issue":"9","key":"5098_CR1","doi-asserted-by":"publisher","first-page":"2285","DOI":"10.3390\/cancers14092285","volume":"14","author":"FY Fang","year":"2022","unstructured":"Fang FY, Rosenblum JS, Ho WS, Heiss JD (2022) New developments in the pathogenesis, therapeutic targeting, and treatment of pediatric Medulloblastoma. 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