Hyperfractionated Versus Conventionally Fractionated Radiotherapy in Standard Risk Medulloblastoma (PNET4)

Inclusion Criteria:

• Age at diagnosis at least 4 years or 5 years (according to the policy of theNational Brain Tumour Group) and less than 22 years.

• Histologically proven medulloblastoma, including the following variants(WHOclassification - 2000): classic medulloblastoma, nodular / desmoplasticmedulloblastoma, melanotic medulloblastoma, medullomyoblastoma No CNS metastasis onMRI - supratentorial, arachnoid of the posterior fossa or spine.

• No clinical evidence of extra-CNS metastasis

• No tumour cells on the cytospin of lumbar CSF. Central Review of CSF cytology isrecommended but not mandatory. It will be left to national policy.

• Radiotherapy to start no more than 40 days after surgery.

• Ability to receive twice daily radiotherapy.

• Vital functions within normal range for their age group.

• CTC grades < 2 for liver, renal, haematological and audiological function.

• No medical contraindication to radiotherapy or chemotherapy.

• Written informed consent (and patient assent where appropriate) according to thelaws of each participating country. Written informed consent should also be soughtfor biological studies.

• National and local ethical committee approval according to the laws of eachparticipating country (to include approval for biological studies).

Exclusion Criteria:

• One of the inclusion criteria is lacking.

• Brainstem or supratentorial primitive neuroectodermal tumour.

• Atypical teratoid rhabdoid tumour.

• Medulloepithelioma.

• Ependymoblastoma.

• Large cell médulloblastoma.

• Metastatic medulloblastoma (on CNS MRI and/or positive cytospin of postoperativelumbar CSF).

• Patient previously treated for a brain tumour or any type of malignant disease.

• Patients who are pregnant.

• Females who are sexually active and not taking reliable contraception.

• Known predisposition to medulloblastoma e.g. Gorlin's syndrome.