Sources of stress, psychological distress and burnout in psychiatrists

AimsTo assess the degree of psychological morbidity and burnout in 138 psychiatrists in three Manchester teaching hospitals.ResultsThe results for senior house officers (SHOs), registrars, senior registrars and consultants were compared. The overall response rate was 76.8%. There was no significant difference in psychological morbidity between the three training grades, but SHOs and registrars reported significantly higher levels of burnout than either senior registrars or consultants. Dealing with violent patients was stressful for all psychiatrists, no matter what the grade.Clinical implicationsFactors related to job stress in psychiatry need to be addressed. In particular, the provision of safer working environments needs to be considered for psychiatrists at all levels of training.

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Pananemia 2008 multicenter observational study on erythropoietin beta treatment in patients with cancer: Efficacy, patient satisfaction, and impact on psychological distress

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e20695 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e20695-e20695

Author(s):

S. Del Prete ◽

R. Addeo ◽

L. Leo ◽

S. Cinieri ◽

V. Lorusso ◽

...

Keyword(s):

Patient Satisfaction ◽

Psychological Distress ◽

Cancer Patients ◽

Overall Response Rate ◽

Response Rate ◽

Multicenter Observational Study ◽

Overall Response ◽

To Receive ◽

Self Administered Questionnaire ◽

Anemia Treatment

e20695 Background: Cancer-related anemia, results in both a need for transfusions and a decreased functional capacity and quality of life. Treating anemia associated with chemotherapy and many cancers is often necessary. However, patient satisfaction with anemia treatment, and the possible correlation between anemia and psychological distress frequently present in these patients is limited by the lack of validated instruments. Methods: Between January 2008 and December 2008, 591 cancer patients in treatment with erythropoietin beta for anemia were targeted to complete the Psychological Distress Inventory (PDI), a 13-item self-administered questionnaire, and the Patient Satisfaction Questionnaire ( PSQ) at 4 week intervals, a 10-item, self-administered questionnaire. Data from weeks 5 and 9 were analyzed. Patients were required to receive at least four weekly injections of Epo, expecting to receive ≥ 8 additional weeks of chemotherapy, and able to complete questionnaires. Results: Among patients fulfilling eligibility criteria and having received at least four Epo Beta administrations, most (57.5%) of them were female, with a median age of 66 (52.4 - 76.5), and a median KPS of 85 (range: 50–100). 399 patients had a stage IV cancers. Hemoglobin values increased from mean baseline levels of 9.55 g/dL, to attain levels 10.31 at week 5, and 11.05 after 8 weeks of therapy; 247 (42%) patients received iron supplementation. For PDI, the overall response rate was 93 % (548/591) at baseline, 100 % (517/517) at week 5, and 99% (491/492) at week 9. The percentage of patients with psychological difficulties decreased during the treatment. For PSQ, the overall response rate was 100% (517/517) at week 5, and 100 % (492/492) at week 9. The PSQ questionnaires showed that a conspicuous group of patients (124/517) marked troubles to accept the treatment. Conclusions: Our results suggest that in anemic cancer patients psychological distress and anemia were related. PSQ reflect the burden of injection anemia treatment on cancer patients. Final data analysis will be presented. No significant financial relationships to disclose.

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A phase II study of docetaxel and gemcitabine in the treatment of recurrent ovarian, peritoneal, and fallopian tube cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.15006 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 15006-15006

Author(s):

M. S. Shahin ◽

P. Hanjani ◽

S. Nolte

Keyword(s):

Fallopian Tube ◽

Overall Response Rate ◽

Response Rate ◽

Single Agent ◽

Hematologic Toxicity ◽

Fallopian Tube Cancer ◽

Overall Response ◽

Platinum Sensitive ◽

Significant Difference ◽

Grade 3

15006 Background: The aim of this trial was to investigate the efficacy and toxicity of weekly combination of docetaxel (D) and gemcitabine (G) in the management of recurrent ovarian, peritoneal, or fallopian tube cancer. Methods: D (30 mg/m2) was given as a one-hour IV infusion followed by G (650 mg/m2) as a 30 minute IV infusion on Day 1, 8 & 15 of a 28-day cycle. Results: Thirty pts were enrolled. Mean age was 67.4 (range 47–85). Twelve (40%) pts had Platinum sensitive disease, and 18 (60%) had Platinum resistant disease. One hundred eighteen cycles were evaluable for toxicity. The mean number of cycles was 4 (range 1–7). Twenty-six (22%) of the cycles were incomplete due to toxicity (day # 15 not given in 25 of the incomplete cycles). Dose delay was observed in 4 (13.3%) pts, and a one-dose level reduction was required in 11 (36.7%) pts. Hematologic toxicity included grade 3 neutropenia in 13 (11%) cycles, grade 3 thrombocytopenia in 11 (9.3%) cycles. No grade 4 neutropenia, thrombocytopenia or neutropenic fever was encountered. Bone marrow support with erythropoiten (36.6% pts), and filgrastim (13.3% pts) were utilized. Blood transfusions were given in 10 (8.5%) cycles. Elevated LFT grade 1/2 was seen in 7 (23.3%) pts and 3 (10%) pts, respectively. Nonhematologic grade 3 toxicites occurred in 4 pts (including one seizure). Mean follow-up interval was 19.6 months (mos) (range 1–36.6). To date, 14 (46.6%) pts are alive with disease, and 16 (53.4%) have died of disease. The overall response rate was 32% (1 CR and 8 PR in 28 evaluable pts). Ten pts (33.3%) had SD and 5 had ID. Median progression-free interval (PFI) was 3.8 mos (95% CI: 1.65–5.97). Overall survival was 19.6 mos (95% CI: 14.23–24.96), and no significant differences in PFI and survival between the Platinum-sensitive and resistant pts (P = 0.5, P = 0.08, respectively). Conclusions: Weekly docetaxel plus gemcitabine is an active and tolerable regimen with minimal toxicity in this older population of pts (9 ≥ 80 years of age). No significant difference in response between Platinum sensitive and resistant pts was observed. Overall response rate appears to be better than single agent regimens currently available. Elimination of the third week of treatment may not affect efficacy and will be more acceptable to pts with less toxicity. No significant financial relationships to disclose.

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Interferon Alpha May Improve the prognosis of Advanced Myeloproliferative Neoplasm Patients with JAK2V617F Mutations

Blood ◽

10.1182/blood.v124.21.5547.5547 ◽

2014 ◽

Vol 124 (21) ◽

pp. 5547-5547

Author(s):

Liu Xiaoli ◽

Li Ding ◽

Na Xu ◽

Bintao Huang ◽

Xuan Zhou ◽

...

Keyword(s):

Survival Rate ◽

Adverse Reactions ◽

Overall Response Rate ◽

Response Rate ◽

Progression Free Survival ◽

Essential Thrombocytosis ◽

Free Survival ◽

Overall Response ◽

Significant Difference ◽

Hydroxyurea Therapy

Abstract Objective Whetherinterferon alpha (IFN-α) has special therapeutic effect formyeloproliferative neoplasm (MPN) patients with JAK2V617F mutations was not widely confirmed. Our purpose was to evaluate the therapeutic effect of interferon alpha (IFN-α) in MPN patients with JAK2V617F mutations. Methods A total of 99 advanced MPN patients (including 68 polycythemia vera (PV) patients with 34 JAK2V617F mutations and 68 essential thrombocytosis (ET) with JAK2V617F mutations) patients) were enrolled to the study during 2007 to 2013 with informed consent, then they were divided into two groups: the IFN-α group (patients received a standard dose of IFN-α with (30-50)ug/d ) and the Hydroxyurea (HU) group (patients received a a dose of (0.25-0.5)g/d for HU). The progression-free survival rate were analyzed for a median of 32.0 (6.0 to 60.0) months follow-up period. Results The overall response rate between IFN-α and Hydroxyurea therapy groups of essential thrombocytosis (ET) patients with JAK2V617F mutations had no significant difference (88.2% vs 85.0%, P>0.05), but the 5-year progression-free survival rate of two groups showed significant difference (88.2% vs 55.0%, P<0.05). The overall response rate (78.6% vs 82.4% ) and 5-year progression-free survival rate (57.1% vs 58.8%) between IFN-α and Hydroxyurea therapy groups of ET patients without JAK2V617F mutations had no significant difference (P>0.05). The overall response rate between IFN-α and Hydroxyurea therapy groups of polycythemia vera (PV) patients with JAK2V617F mutations had no significant difference (80.0% vs 75%, P>0.05), but the 5-year progression-free survival rate of IFN-α and Hydroxyurea therapy groups showed significant difference (86.7% vs 50.0%, P<0.05). After the treatment of IFN-α and HU for six months, the ratio of Interferon-treated patients need to continue phlebotomy was significantly lower than hydroxyurea therapy group (8.3% vs 58.3%, P<0.05). The thromboembolic events,splenomegaly, bone marrow fibrosis of interferon treatment group were lower than hydroxyurea treatment group showed significant difference (P<0.05). The adverse reactions of IFN-α was moderate, most of the patients in this study could tolerate the therapy. The major side effect of hydroxyurea was hematologic adverse reactions (Grade 1-2) with mainly reduce of white blood cells and thrombocytopenia, which showed difference between IFN-α and hydroxyurea (P<0.05). Conclusions IFN-α may improve the prognosis of ET and PV patients with JAK2V617F mutations. Moreover, patients with PV and JAK2V617F mutations may be benefit for the treatment of IFN-α and could be recommended for an effective choice. Disclosures No relevant conflicts of interest to declare.

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Crisis intervention: the professionals' perspective

Psychiatric Bulletin ◽

10.1192/pb.25.3.95 ◽

2001 ◽

Vol 25 (3) ◽

pp. 95-98 ◽

Cited By ~ 1

Author(s):

Fernando Lazaro ◽

Elena Kulinskaya ◽

Robert Tobiansky

Keyword(s):

Crisis Intervention ◽

Overall Response Rate ◽

Response Rate ◽

Clinical Implications ◽

Staff Satisfaction ◽

Overall Response ◽

Clinical Responsibility ◽

Intervention Service ◽

Differences Of Opinion ◽

Professional Disciplines

Aims and MethodTo describe the attitudes of the professionals of a multi-disciplinary crisis intervention service (CIS) towards the service they provide. To establish whether there are differences in attitudes between the different professional disciplines involved. A questionnaire was mailed to all the professionals working in the Barnet CIS (n=94). Differences were analysed using the Kruskal–Wallis test.ResultsThe overall response rate was 84%. Statistically significant differences were found between the different disciplines in 10 of the 37 questions (27%) on the questionnaire. Opinions differed most on issues of safety and acceptance of clinical responsibility.Clinical ImplicationsDespite general ag reement on most issues, we found differences of opinion in important areas such as arrangements for team safety and clinical responsibility. These differences may create tensions within the multi-disciplinary groups and may influence the attitudes of professionals to crisis work. Measures need to be taken to address these issues in order to improve morale and staff satisfaction.

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Influence of mailing strategies on response to questionnaires

Psychiatric Bulletin ◽

10.1192/pb.22.11.692 ◽

1998 ◽

Vol 22 (11) ◽

pp. 692-694 ◽

Cited By ~ 2

Author(s):

Kate Newton ◽

Samuel M. Stein ◽

Clare Lucey

Keyword(s):

Prospective Study ◽

Child Psychiatry ◽

Overall Response Rate ◽

Response Rate ◽

Clinical Information ◽

Clinical Implications ◽

Questionnaire Response ◽

Overall Response ◽

Patient Questionnaires ◽

A Prospective Study

Aims and methodA prospective study was undertaken to evaluate the effect of a stamped addressed envelope, as compared to a non-stamped but addressed envelope or no envelope, on response to a mailed questionnaire. The correlation between questionnaire response and subsequent attendance at the first appointment was also studied.ResultsThe overall response rate was 26% of 176 families offered first appointments at a local child psychiatry service. Families provided with a stamped addressed envelope were more likely to return their questionnaire and those families who returned the questionnaire were more likely to attend their first appointment.Clinical implicationsThe return of patient questionnaires has significant clinical and resource implications. Only essential questionnaires should be sent out to referred families as nearly three-quarters will not be returned. The return rate can be enhanced by providing a stamped addressed envelope but, if questionnaires are not returned within 10 days, the likelihood of return is minimal. As more than half of the families who failed to return the questionnaire also failed to attend their first appointment, questionnaires can be used as a measure of motivation and likelihood of attendance as well as a source of clinical information.

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Up-Front Treatment of Diffuse Large-B Cell Lymphoma (DLBCL) in Elderly Patients with Rituximab in Combination with CHOP-Like Chemotherapy: A Multicenter Study on the Current Clinical Management.

Blood ◽

10.1182/blood.v106.11.4778.4778 ◽

2005 ◽

Vol 106 (11) ◽

pp. 4778-4778 ◽

Cited By ~ 1

Author(s):

Miguel A. Canales ◽

Javier de la Serna ◽

Pilar Sabin ◽

Joaquin Diaz-Mediavilla ◽

Mariano Provencio ◽

...

Keyword(s):

Overall Survival ◽

Clinical Practice ◽

Adverse Events ◽

Elderly Patients ◽

Overall Response Rate ◽

Response Rate ◽

B Cell Lymphoma ◽

Overall Response ◽

Significant Difference

Abstract Based on results of GELA study, rituximab in combination with CHOP chemotherapy, given for eight cycles, may be considered the new standard of care for patients older than 60 years diagnosed with DLBCL. However, the afraid of early toxicity and underlying co-morbid illness in elderly patients implies often adjustments in this scheme. The aim of this study was to analyze the routine clinical practice in the up-front treatment of elderly patients (>65 years) with DLBCL. We have enrolled onto this study 80 patients (48 females) with median age 74 years (range, 65 to 85 years) who have been treated with CHOP-like regimens in combination with rituximab as first-line therapy. The 75% of patients had ECOG 0-1, 81% had Ann-Arbor stage III-IV, 41% had B-symptoms, 59% had aIPI 2-3, 39% had bulky disease (> 7 cm) and 55% had elevated beta-2 microglobulin. The most of patients received as up-front therapy R-CHOP (89%); R-CNOP and R-CEOP (doxorubicin is substituted for mitoxantrone and epirubicin, respectively) were the alternative regimens administered. The 57.5% of patients received 6 courses of treatment; the 25% received less than 6 cycles and only the 6% of patients (5 out of 80 patients) received 8 courses of treatment. In 31 out of 80 patients the doses of chemotherapy was reduced; in 20 patients the doses of chemotherapy were reduced in all courses and 2 patients received reduced doses of chemotherapy in 5 out of 6 cycles. In the 40% of patients G-CSF have been administered. The overall response rate was 86% (72% CR/CRu, 14% PR). In the 22 patients who received the lower doses of chemotherapy the overall response rate was 82% (50% CR/CRu) versus 88% in the remaining patients (81% CR/CRu) (p<0.05). Adverse events were observed in the 47.5% of patients and neutropenia was the most frequent complication. In those patients who received reduced doses of chemotherapy less adverse events were observed (13.6% versus 60.3%, p<0.001). With a median follow-up of 15 months, the event-free survival in the assessable population has not been reached (60% at 2 years) and there was no significant difference in those patients who have received the reduced doses of chemotherapy (median 18.5 months versus not reached). The median overall survival has not been reached. At 2 years overall survival is 73% in the entire population and 51% in patients receiving the reduced doses of chemotherapy compared to 80% in the remaining patients but the difference was not statistically significant. In conclusion, in our current clinical practice, 6 courses of chemotherapy (CHOP-like) in combination with rituximab is the commonest regimen used for the treatment of elderly patients. The administration of reduced doses of chemotherapy is associated with both a significant decrease in adverse events and complete response rates and may be translated into a shorter event-free and overall survival. A longer follow-up may be necessary to reveal this difference. Logically, randomized trials are mandatory to address differences between 6 and 8 courses of immunochemotherapy in this population.

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Safety and Efficacy of Two Doses of Tandospirone Citrate for Generalized Anxiety Disorder: A Multicenter Randomized Controlled Trial

10.21203/rs.3.rs-800448/v1 ◽

2021 ◽

Author(s):

Qingwei Li ◽

Haiyin Zhang ◽

Guozhen Lin ◽

Shenxun Shi ◽

Yingli Zhang ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Overall Response Rate ◽

Response Rate ◽

Controlled Trial ◽

Generalized Anxiety ◽

High Dose ◽

Safety And Efficacy ◽

Overall Response ◽

Randomized Controlled ◽

Significant Difference

Abstract Background This study aimed to determine the safety and efficacy of different doses of tandospirone to treat generalized anxiety disorder (GAD). Methods This parallel randomized controlled trial involved patients with GAD from eight centers in China between 01/2012 and 09/2018. Patients were randomly assigned to 60 mg/day and 30 mg/day groups. The primary endpoint was the overall response rate at the end of week 6. The secondary endpoints included significant response rate, change in Hamilton Anxiety Scale (HAMA) total score, HAMA subscale score, Hamilton Depression Scale-17 (HAMD-17), and adverse drug reactions. Results No significant difference was found in the overall response rate (65.7% vs 58.4%, P > 0.05) between 60 mg/day and 30 mg/day groups. The significant response rate (34.3% vs 22.6%, P = 0.032) was better in the 60 mg/day group. The reduction in HAMA total score, somatic anxiety factor, cardiovascular symptom factor, gastrointestinal symptom factor, and HAMD-17 score were better in the 60 mg/day group (all P < 0.05). The incidence of dizziness and gastrointestinal reactions of the 60 mg/day group was higher than that of the 30 mg/day group. However, there was no significant difference in the proportion of withdrawal due to adverse events. Conclusions For GAD treatment, the overall response rate of high-dose tandospirone was similar to that of low-dose tandospirone. The safety in the two groups was tolerable. Patients with good compliance might benefit from a high-dose regimen. Trial registration: The trial registration no. was NCT01614041(07/06/2012).

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The Clinical Study of Combination of Bortezomib and Dexamethasone in Treatment of Newly Diagnosed Multiple Myeloma

Blood ◽

10.1182/blood.v112.11.5217.5217 ◽

2008 ◽

Vol 112 (11) ◽

pp. 5217-5217

Author(s):

Juan Li ◽

Lijin Zeng

Keyword(s):

Multiple Myeloma ◽

Complete Remission ◽

Adverse Effects ◽

Overall Response Rate ◽

Response Rate ◽

Common Adverse Event ◽

Control Group ◽

Newly Diagnosed ◽

Overall Response ◽

Significant Difference

Abstract OBJECTIVE: To study retrospectively the response and side effects in two groups of patients with newly diagnosed multiple myeloma (MM) receiving bortezomib and dexamethasone regimen (VD) and vincristine combined with pirarubicin and dexamethasone and melphalan regimen (VADM). METHODS: Nineteen patients were enrolled in a group of VD, receiving bortezomib 1.3mg/m2 on days 1,4,8,11 and dexamethasone 20mg on days 1–4 in a 21-day cycle. Blade Standard was used to evaluate the therapeutic effect and NCI-CTC was used to assess the adverse effect. Thirty-one matched patients with newly diagnosed MM who received VADM were used as a historical control group, receiving vincristine 0.4mg/d and pirarubicin 9mg•m−2•d−1 and dexamethasone 20mg/d and melphalan 12mg/d on days 1–4, with 28 days as a cycle. RESULTS: During the median 9 months’ follow-up of patients who received VD, there were 73.7% patients(14/19)responding to the treatment, including 9 cases (47.4%) of complete remission or near complete remission. Light-chain type patients who received VD had a higher overall response rate and CR +nCR rate than that of the VADM (P<0.05). The patients receiving VD who had renal inadequacy had an effective rate of 69.6% (5/6), which was similar to that of the others (69.2%, 9/13), and renal function relieve could be shown in the chemotherapy. The main adverse effects were fatigue, diarrhea, peripheral neuropathy, thrombocytopenia, and infection, with incidences of 73.8%, 68.4%, 63.2%, 31.5% and 26.3% respectively. Most of the adverse effects were mild and could be relieved by symptomatic treatments. The most common adverse event in the control group was neutropenia (83.8%), followed by infection(35.5%), vomiting (35.5%) and loss of hair(32.5%). CONCLUSION: Although there was no significant difference of overall response rate between VD and VADM, VD has higher CR +nCR rate compared with VADM. VD can be tolerant in most patients, and is also safe in patients with renal inadequacy.

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Survival Impact of Rituximab Combined to ACVBP (R-ACVBP) in 209 Poor Risk Diffuse Large B-Cell Lymphoma (DLBCL) Patients Treated with Upfront High-Dose Consolidative Autotransplantation (HDC) : A GELA Phase II Study

Blood ◽

10.1182/blood.v112.11.771.771 ◽

2008 ◽

Vol 112 (11) ◽

pp. 771-771 ◽

Cited By ~ 1

Author(s):

Christian Gisselbrecht ◽

Olivier Fitoussi ◽

Karim Belhadj ◽

Nicolas Mounier ◽

Pierre Feugier ◽

...

Keyword(s):

Complete Remission ◽

Overall Response Rate ◽

Response Rate ◽

Remission Rate ◽

B Cell Lymphoma ◽

Complete Remission Rate ◽

Induction Treatment ◽

High Dose ◽

Overall Response ◽

Significant Difference

Abstract Rituximab (R) combined with CHOP improves complete remission rate and PFS, OS in DLBCL pts. More intensive regimen followed by HDC have been used in patients < 60y with with 2–3 adverse age-adjusted International-Prognostic-Index (aa-IPI) factors, providing a 5y OS of 65% (CI 60–68%), (Haioun LNH 98-3B ASCO 2007). The objective of the study was to see if combining R (375 mg/m2) to the dose intense ACVBP (Doxorubicin 75 mg/m2 d1, Cyclophosphamide 1,200 mg/m2 d1, Vindesine 2 mg/m2 and Bleomycin 10 mg d1 and d5, prednisone 60 mg/m2 d1–d5) translates into an improvement of response rate and also PFS, OS, EFS in pts under 60y with DLBCL and aaIPI 2 or 3. Four cycles of R-ACVBP were delivered every 15 days supported by G CSF. Responding pts received a consolidative BEAM and peripheral blood stem cell rescue. From 01/2004 to 12/2005, 209 DLCBL pts were enrolled. Median age was 49 years (range: 18–60), 22 % with aa-IPI 3, 19 % with bone marrow involvement, 93% with LDH> 1N and 54 % with extranodal sites > 1. Based on International Workshop Criteria, CR+CRu rate after induction treatment was 61%, PR rate 24%, stable disease 2% and progressive disease 1% heading an overall response rate of 84% (176pts). Deaths occurred in 4% of the pts. Hematological toxicity was similar to that observed in previous GELA trials using ACVBP. Collection failure after the 3rd and/or 4th R-ACVBP cycle was observed in 18 pts (10%), Consequently 157 pts were responders and had successful mobilization. Among responding pts, 155 pts received HDC, representing 75% of the whole population. Four patients died without progression during the HDC procedure. At the end of treatment, the overall response rate was 81% with 150 pts (72%) considered in complete remission, 9% in PR and 4% progressed. With a median follow-up of 27 months, using the updated IWC 2007, three-year PFS was 76% (CI 69–81%), and 85% for pts submitted to HDC; OS was 81% (CI 75–86%) and 90% for pts submitted to HDC, finally EFS was 60% (CI 53–66%), and 83% for pts submitted to HDC. For pts with IPI 2 or 3, 3 y PFS were 84%–92% and OS 89%–95% respectively without significant difference. There was no significant difference between pts in CR or PR before transplant. No other prognostic factors could be isolated in multivariate analysis. We conclude that with R-ACVBP induction regimen, 75% of the patients could received HDC. There is an increase of complete remission rate after HDC according the criteria used. An impressive PFS of 76% and OS 81% were observed even in patients with 3 adverse factors. Comparison with previous study without rituximab in induction suggests a major improvement which needs confirmatory prospective randomized study.

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Cisplatin in the treatment of recurrent childhood primary brain tumors.

Journal of Clinical Oncology ◽

10.1200/jco.1988.6.1.62 ◽

1988 ◽

Vol 6 (1) ◽

pp. 62-66 ◽

Cited By ~ 89

Author(s):

R W Walker ◽

J C Allen

Keyword(s):

Brain Tumors ◽

Germ Cell ◽

Germ Cell Tumor ◽

Overall Response Rate ◽

Response Rate ◽

Cell Tumor ◽

Primitive Neuroectodermal Tumors ◽

Primary Brain Tumors ◽

Overall Response ◽

Neuroectodermal Tumors

Thirty-three patients were treated with intravenous (IV) cisplatin (CPDD) of whom 32 were considered evaluable. There were 14 medulloblastomas, five primitive neuroectodermal tumors (PNET), nine gliomas, three ependymomas, and one germ cell tumor. The overall response rate was 13 of 32 (41%). Eleven responses (five complete [CR], five partial [PR], one mixed [MR]) were noted in the patients with medulloblastoma. The response rate within this group was 79%. Toxicity was tolerable, although it precluded further therapy in five patients.

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