The treatment of adults with medulloblastoma: a prospective study.
OBJECTIVE
To assess in a prospective trial the value of prognostic factors and the outcome of medulloblastoma in adults.


METHODS
Patients (> or =18 years) with a histologic diagnosis of medulloblastoma were staged according to Chang et al.'s classification (low risk: T1, T2, T3a, M0, and no residual disease after surgery; high risk: T3b-T4, any M+ or postoperative presence of residual tumor). In low-risk patients, treatment consisted of 36 Gy to the craniospinal axis, supplemented by a local tumor dose of 18.8 Gy (total dose of 54.8 Gy). In high-risk patients, 2 cycles of "up-front chemotherapy" were delivered before the same radiation therapy, followed by maintenance chemotherapy if M1, M2, or M3 disease was present.


RESULTS
Over a 12-year period, 36 evaluable patients were enrolled. Progression-free survival (PFS) at 5 years was higher in low-risk patients compared to the high-risk group: 76% +/- 14% (95% confidence interval [CI] = 52%-100%) vs. 61% +/- 11% (95% CI = 42%-87%). Patients with M- disease showed a significantly better outcome than M+ patients, with 75% showing PFS at 5 years vs. 45% (p = 0.01).


CONCLUSIONS
The overall PFS observed is comparable to that obtained in pediatric series and suggests that a more effective therapy must be developed for high-risk patients.
Brandes
Alba A
AA
Department of Medical Oncology, Azienda Ospedale-Università of Padova, Padova, Italy. aabrandes@unipd.it
Ermani
Mario
M
Amista
Pietro
P
Basso
Umberto
U
Vastola
Francesca
F
Gardiman
Marina
M
Iuzzolino
Paolo
P
Turazzi
Sergio
S
Rotilio
Antonino
A
Volpin
Lorenzo
L
Mazza
Carlo
C
Sainati
Laura
L
Ammannati
Franco
F
Berti
Franco
F
D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008466:Mechlorethamine / Q000008:administration & dosage; D008527:Medulloblastoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000209:etiology; D011241:Prednisone / Q000008:administration & dosage; D011344:Procarbazine / Q000008:administration & dosage; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D014750:Vincristine / Q000008:administration & dosage
D011344:Procarbazine; D008466:Mechlorethamine; D014750:Vincristine; D011241:Prednisone