{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:37:52Z","timestamp":1789691872246,"version":"4.0.1"},"reference-count":45,"publisher":"American Society of Clinical Oncology (ASCO)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCO"],"published-print":{"date-parts":[[2001,5,15]]},"abstract":"<jats:p> PURPOSE: This study was designed to determine the feasibility and safety of delivering four consecutive cycles of high-dose cyclophosphamide, cisplatin, and vincristine, each followed by stem-cell rescue, every 4 weeks, after completion of risk-adapted craniospinal irradiation to children with newly diagnosed medulloblastoma or supratentorial primitive neuroectodermal tumor (PNET). <\/jats:p><jats:p> PATIENTS AND METHODS: Fifty-three patients, 19 with high-risk disease and 34 with average-risk disease, were enrolled onto this study. After surgical resection, high-risk patients were treated with topotecan in a 6-week phase II window followed by craniospinal radiation therapy and four cycles of high-dose cyclophosphamide (4,000 mg\/m<jats:sup>2<\/jats:sup> per cycle), with cisplatin (75 mg\/m<jats:sup>2<\/jats:sup> per cycle), and vincristine (two 1.5-mg\/m<jats:sup>2<\/jats:sup> doses per cycle). Support with peripheral blood stem cells or bone marrow and with granulocyte colony-stimulating factor was administered after each cycle of high-dose chemotherapy. Treatment of average-risk patients consisted of surgical resection and craniospinal irradiation, followed by the same chemotherapy given to patients with high-risk disease. The expected duration of the chemotherapy was 16 weeks, with a cumulative cyclophosphamide dose of 16,000 mg\/m<jats:sup>2<\/jats:sup> and a planned dose-intensity of 1,000 mg\/m<jats:sup>2<\/jats:sup>\/wk. <\/jats:p><jats:p> RESULTS: Fifty of the 53 patients commenced high-dose chemotherapy, and 49 patients completed all four cycles. The median length of chemotherapy cycles one through four was 28, 27, 29, and 28 days, respectively. Engraftment occurred at a median of 14 to 15 days after infusion of stem cells or autologous bone marrow. The intended dose-intensity of cyclophosphamide was 1,000 mg\/m<jats:sup>2<\/jats:sup>\/wk; the median delivered dose-intensity was 1,014, 1,023, 974, and 991 mg\/m<jats:sup>2<\/jats:sup>\/wk for cycles 1 through 4, respectively; associated median relative dose-intensity was 101%, 102%, 97%, and 99%. No deaths were attributable to the toxic effects of high-dose chemotherapy. Early outcome analysis indicates a 2-year progression-free survival of 93.6% \u00b1 4.7% for the average-risk patients. For the high-risk patients, the 2-year progression-free survival is 73.7% \u00b1 10.5% from the start of therapy and 84.2% \u00b1 8.6% from the start of radiation therapy. <\/jats:p><jats:p> CONCLUSION: Administering four consecutive cycles of high-dose chemotherapy with stem-cell support after surgical resection and craniospinal irradiation is feasible in newly diagnosed patients with medulloblastoma\/supratentorial PNET with aggressive supportive care. The early outcome results of this approach are very encouraging. <\/jats:p>","DOI":"10.1200\/jco.2001.19.10.2696","type":"journal-article","created":{"date-parts":[[2017,2,24]],"date-time":"2017-02-24T07:20:52Z","timestamp":1487920852000},"page":"2696-2704","source":"Crossref","is-referenced-by-count":138,"title":["Feasibility of Four Consecutive High-Dose Chemotherapy Cycles With Stem-Cell Rescue for Patients With Newly Diagnosed Medulloblastoma or Supratentorial Primitive Neuroectodermal Tumor After Craniospinal Radiotherapy: Results of a Collaborative Study"],"prefix":"10.1200","volume":"19","author":[{"given":"Douglas","family":"Strother","sequence":"first","affiliation":[{"name":"From the Department of Pediatrics, Baylor College of Medicine, Houston, TX; Departments of Hematology-Oncology and Biostatistics and Epidemiology, Division of Neurology, St Jude Children\u2019s Research Hospital, and Department of Pediatrics, College of Medicine, University of Tennessee, Memphis, TN; and Department of Hematology Oncology, Royal Children\u2019s Hospital, Melbourne, the Oncology Unit, The Children\u2019s Hospital at Westmead, and The University of Sydney, Sydney, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ashley","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Baylor College of Medicine, Houston, TX; Departments of Hematology-Oncology and Biostatistics and Epidemiology, Division of Neurology, St Jude Children\u2019s Research Hospital, and Department of Pediatrics, College of Medicine, University of Tennessee, Memphis, TN; and Department of Hematology Oncology, Royal Children\u2019s Hospital, Melbourne, the Oncology Unit, The Children\u2019s Hospital at Westmead, and The University of Sydney, Sydney, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stewart J.","family":"Kellie","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Baylor College of Medicine, Houston, TX; Departments of Hematology-Oncology and Biostatistics and Epidemiology, Division of Neurology, St Jude Children\u2019s Research Hospital, and Department of Pediatrics, College of Medicine, University of Tennessee, Memphis, TN; and Department of Hematology Oncology, Royal Children\u2019s Hospital, Melbourne, the Oncology Unit, The Children\u2019s Hospital at Westmead, and The University of Sydney, Sydney, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akta","family":"Patel","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Baylor College of Medicine, Houston, TX; Departments of Hematology-Oncology and Biostatistics and Epidemiology, Division of Neurology, St Jude Children\u2019s Research Hospital, and Department of Pediatrics, College of Medicine, University of Tennessee, Memphis, TN; and Department of Hematology Oncology, Royal Children\u2019s Hospital, Melbourne, the Oncology Unit, The Children\u2019s Hospital at Westmead, and The University of Sydney, Sydney, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Jones-Wallace","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Baylor College of Medicine, Houston, TX; Departments of Hematology-Oncology and Biostatistics and Epidemiology, Division of Neurology, St Jude Children\u2019s Research Hospital, and Department of Pediatrics, College of Medicine, University of Tennessee, Memphis, TN; and Department of Hematology Oncology, Royal Children\u2019s Hospital, Melbourne, the Oncology Unit, The Children\u2019s Hospital at Westmead, and The University of Sydney, Sydney, Australia."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Thompson","sequence":"additional","affiliation":[{"name":"From the Department of Pediatrics, Baylor College of Medicine, Houston, TX; 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