title: Medulloblastoma: is the 5-year survival rate improving? A review of 80 cases from a single institution.
abstract: A series of 80 cases of medulloblastomas in children undergoing operation and postoperatively followed between 1980 and 1990 at Great Ormond Street Hospital for Children (GOSH) has been reviewed and compared to an earlier series reported from the same institution by McIntosh. The overall 5-year survival rate for the present series was 50%, although three patients died after surviving 5 years. The operative mortality rate was 5%. Survival analysis revealed that the presence or absence of spinal metastases and the necessity for some form of cerebrospinal fluid diversion within 30 days of the operation independently significantly affected survival in this series. Those patients with no spinal metastasis and total tumor removal had a 5-year survival rate of 73%, making this the most favorable subgroup in the series. Patient age and gender, duration of symptoms, Chang T stages, tumor volume, extent of resection, and postoperative chemotherapy were not significant variables. Although these results are better than those reported in the earlier GOSH series, they are not significantly different from the results of the second 5-year cohort of patients described in that article. Radiotherapy remains the greatest advance in treatment, although it is hoped that further improvement will result from the various chemotherapy protocols now being studied and from increasing knowledge of the biological behavior of these tumors.
authors.affiliation: Department of Neurosurgery, Great Ormond Street Hospital for Children National Health Service Trust, London, England.
authors.forename: K M
authors.initials: KM
authors.lastname: David
authors.forename: A T
authors.initials: AT
authors.lastname: Casey
authors.forename: R D
authors.initials: RD
authors.lastname: Hayward
authors.forename: W F
authors.initials: WF
authors.lastname: Harkness
authors.forename: K
authors.initials: K
authors.lastname: Phipps
authors.forename: A M
authors.initials: AM
authors.lastname: Wade
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D002528:Cerebellar Neoplasms / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery; D009192:Myelography; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D010166:Palliative Care; D018714:Radiotherapy, Adjuvant; D013125:Spinal Neoplasms / Q000556:secondary; D015996:Survival Rate; D014057:Tomography, X-Ray Computed