title: Survival of adults treated for medulloblastoma using paediatric protocols.
abstract: We retrospectively studied 26 consecutive adults treated for medulloblastoma using paediatric protocols. Between 1987 and 2003, patients 18 years old were given adjuvant chemotherapy consisting of one of two 'paediatric' regimens (depending on the time of presentation) and craniospinal local-boost radiotherapy: regimen A (n = 12), vincristine (VCR), intrathecal and/or intravenous methotrexate and conventional radiotherapy; or regimen B (n = 11) sequencing intensive doses of multiple agents followed by hyperfractionated accelerated radiotherapy (HART). A VCR-lomustine-based maintenance followed both regimens. Three additional patients received a tailored treatment due to their impaired neurological status after surgery. The median age at diagnosis was 26 years (range 18-41 years). With a median follow-up of 46 months, 5-year disease-free and overall survival rates were 65+/-11% and 73+/-10%, respectively, for the series as a whole. All patients who received regimen B (5 of whom had metastatic Chang M2-M3 disease) are alive with no evidence of disease at 39 months. Although the number of patients is limited, our data suggest that the sandwich sequential, moderately intensive chemotherapy in combination with HART is an effective treatment for medulloblastoma in adults, and this approach seems to overcome previously-recognised risk factors.
authors.affiliation: Paediatric Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. filippo.spreafico@institutotumori.mi.it
authors.forename: Filippo
authors.initials: F
authors.lastname: Spreafico
authors.forename: Maura
authors.initials: M
authors.lastname: Massimino
authors.forename: Lorenza
authors.initials: L
authors.lastname: Gandola
authors.forename: Graziella
authors.initials: G
authors.lastname: Cefalo
authors.forename: Elena
authors.initials: E
authors.lastname: Mazza
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Landonio
authors.forename: Emanuele
authors.initials: E
authors.lastname: Pignoli
authors.forename: Geraldina
authors.initials: G
authors.lastname: Poggi
authors.forename: Monica
authors.initials: M
authors.lastname: Terenziani
authors.forename: Paolo
authors.initials: P
authors.lastname: Pedrazzoli
authors.forename: Salvatore
authors.initials: S
authors.lastname: Siena
authors.forename: Franca
authors.initials: F
authors.lastname: Fossati-Bellani
mesh_terms: D000284:Administration, Oral; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D017024:Chemotherapy, Adjuvant / Q000379:methods; D016371:Cranial Irradiation / Q000379:methods; D018572:Disease-Free Survival; D006801:Humans; D007262:Infusions, Intravenous; D008130:Lomustine / Q000008:administration & dosage / Q000009:adverse effects; D008527:Medulloblastoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D014750:Vincristine; D008130:Lomustine; D008727:Methotrexate