Outcomes of a radiation sparing approach in medulloblastoma by subgroup in young children: an institutional review.

OBJECTIVE To describe disease outcomes including overall survival and relapse patterns by subgroup in young pediatric patients treated for medulloblastoma with a radiation-sparing approach. METHODS Retrospective analysis of clinical outcomes includes treatment, relapse, and salvage therapy and late effects in children treated for medulloblastoma with a radiation-sparing approach at British Columbia Children's Hospital (BCCH) between 2000 and 2020. RESULTS There were 30 patients (median age 2.8 years, 60% male) treated for medulloblastoma with a radiation-sparing approach at BCCH. Subgroups included Sonic Hedgehog (SHH) (n = 14), group 3 (n = 7), group 4 (n = 6), and indeterminate status (n = 3). Three- and 5-year event-free survival (EFS) were 49.0% (30.2-65.4%) and 42.0% (24.2-58.9%) and overall survival (OS) 66.0% (95% CI 46.0-80.1%) and 62.5% (95% CI 42.5 and 77.2%), respectively, with a median follow-up of 9.5 years. Relapse occurred in 12/25 patients following a complete response, of whom six (group 4: n = 4; group 3: n = 1; unknown: n = 1) were successfully salvaged with craniospinal axis (CSA) RT and remain alive at a median follow-up of 7 years. Disease/treatment-related morbidity included endocrinopathies (n = 8), hearing loss n = 16), and neurocognitive abnormalities (n = 9). CONCLUSIONS This radiation sparing treatment approach for young patients with medulloblastoma resulted in a durable cure in most patients with SHH subgroup medulloblastoma. In those patients with groups 3 and 4 medulloblastoma, relapse rates were high; however, most group 4 patients were salvaged with RT

Denis Johnston's Jonathan Swift

I am not a Swift scholar. Not being a Swift scholar, I both enjoyed and was impressed by Denis Johnston’s 1959 biographical study In Search of Swift. On the other hand, I understand that most of you, being Swift scholars, may just possibly have enjoyed it, but were not impressed by it. I am not entirely convinced the correct attitude here is so obvious, but it would be absurd for me to come to any biographical conclusions of my own, and in any case Swift’s biography in itself is not my primary concern. I am more concerned with Johnston, and the reaction by the Swift scholarly establishment to what at least he considered his important contribution to Swift scholarship. This reaction, perhaps along with other disappointments of his life connected with the theatre and broadcasting, has contributed to a certain cynicism and bitterness that prevailed in Johnston’s later life, not unhke that which characterized Swift’s own old age. This is despite Johnston’s very real successes in several fields of endeavour. Johnston, among other things a university teacher, clearly saw his scholarly work to be a compelling combination of original research, disciplined logical conclusions, and brilliant insights, likely to revolutionize the prevailing biographical perspective of Swift. He expected to make a considerable academic stir, and in fact had already eighteen years earlier made a minor one. The earlier one having been quite negative, however, he expected this one to be better received. It was not.I am not a Swift scholar. Not being a Swift scholar, I both enjoyed and was impressed by Denis Johnston’s 1959 biographical study In Search of Swift. On the other hand, I understand that most of you, being Swift scholars, may just possibly have enjoyed it, but were not impressed by it. I am not entirely convinced the correct attitude here is so obvious, but it would be absurd for me to come to any biographical conclusions of my own, and in any case Swift’s biography in itself is not my primary concern. I am more concerned with Johnston, and the reaction by the Swift scholarly establishment to what at least he considered his important contribution to Swift scholarship. This reaction, perhaps along with other disappointments of his life connected with the theatre and broadcasting, has contributed to a certain cynicism and bitterness that prevailed in Johnston’s later life, not unhke that which characterized Swift’s own old age. This is despite Johnston’s very real successes in several fields of endeavour. Johnston, among other things a university teacher, clearly saw his scholarly work to be a compelling combination of original research, disciplined logical conclusions, and brilliant insights, likely to revolutionize the prevailing biographical perspective of Swift. He expected to make a considerable academic stir, and in fact had already eighteen years earlier made a minor one. The earlier one having been quite negative, however, he expected this one to be better received. It was not