title: Medulloblastoma in adults: a series from Brazil.
abstract: We retrospectively reviewed 15 adult patients (11 males, median age 34 years; range 23-48) who had been treated and followed in our Institution since 1991 from the time of diagnosis until death or last follow-up in December 2001. Headache was the most frequent symptom (93%). The tumor was hemispheric in 11 patients. Complete resection was achieved in eight. CSF in 12 patients and craniospinal MRI in 6 did not show metastatic disease. Two patients refused adjuvant treatment and died with progressive disease. Thirteen patients received adjuvant craniospinal radiotherapy and 11 systemic chemotherapy. After initial treatment only 2 of the 13 patients relapsed in the posterior fossa. Recurrence was probably related to sub-optimal radiotherapy planning: inadequate low dose in the posterior fossa (37.5 Gy) and long delay in initiating treatment. Two of the 13 patients that received adjuvant treatment died: one from meningitis, and one from recurrent disease. Eleven patients remained alive, and disease-free with Karnofsky performance status ranging 80-100. The median overall survival was not reached after a median follow-up of 5.6 years (range 0.7-10.8 years). Estimated 1-, 5- and 10-year overall survival rates were 86.7%, 72.7%, and 72.7%, respectively. Adult medulloblastoma was predominant in males and the majority of patients had hemispheric tumors. Long-term survival was not uncommon. Although chemotherapy may be useful and well tolerated, radiotherapy remains the mainstay adjuvant treatment as suggested by our two recurrences associated with a delay or inadequate dose.
authors.affiliation: Department of Neurology, Universidade Federal de São Paulo-Escola Paulista de Medicina, São Paulo, SP Brazil. suzana@neuro.epm.br
authors.forename: Suzana M F
authors.initials: SM
authors.lastname: Malheiros
authors.forename: Clélia M R
authors.initials: CM
authors.lastname: Franco
authors.forename: João N
authors.initials: JN
authors.lastname: Stávale
authors.forename: Adrialdo J
authors.initials: AJ
authors.lastname: Santos
authors.forename: Lia R R
authors.initials: LR
authors.lastname: Borges
authors.forename: Maria P
authors.initials: MP
authors.lastname: Pelaez
authors.forename: Fernando A P
authors.initials: FA
authors.lastname: Ferraz
authors.forename: Alberto A
authors.initials: AA
authors.lastname: Gabbai
mesh_terms: D000328:Adult; D001938:Brazil; D002528:Cerebellar Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome