Evidence
There is minimal evidence specifically addressing the utility of PRE in
this clinical setting. However, the evidence previously discussed
regarding primary surgery supports the position that PRE is frequently
not justified. In the SIOP MMT trial, chemotherapy was commonly used
after initial biopsy instead of primary surgery or PRE, and conservative
surgery and/or brachytherapy was utilized for patients who failed to
achieve CR. This treatment paradigm resulted in excellent outcomes with
a 5-year overall survival rate of 91% and a local failure rate of
18%.4, 7