ition to improving overall five-year survival of average-risk patients to 85 percent, this group had an 83 percent rate of event-free survival and a rate of five-year, event-free survival of 70 percent for high-risk patients. Event-free survival means that a child did not have medical complications or relapse that required further treatment.

Moreover, the improved treatment achieved a survival rate of 66 percent as compared to 30-40 percent among children whose cancer had spread.

The results of the current clinical trial, SJMB96, are especially significant because they represent a dramatic change from the 45 percent survival rate achieved two decades ago using just surgery and irradiation, according to Gajjar. The subsequent addition of chemotherapy before or after radiotherapy improved that survival rate to 65 percent for children aged 3 years or older who had medulloblastoma.

"We attribute our very promising results to the early use of high-dose radiotherapy after surgery--rather than waiting until after chemotherapy--in combination with short-term, intense chemotherapy," Gajjar said. "Shorter-term, intense chemotherapy is an especially important component of treatment that contributes to the improved survival of high-risk patients."

The researchers also showed that genetic differences exist in medulloblastoma tissues among children. These differences could be used to differentiate between children whose tumors are very aggressive and require novel experimental treatment and those children whose tumors are less aggressive and who could benefit from further reduction in treatment.

"These additional studies suggest that we can further reduce the long-term effects of treatment among some children by further reducing the treatment intensity," Gajjar said. The researchers previously reported that medulloblastoma consists of several distinct subgroups of this cancer that can be identified according to specific
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