Survival of adults treated for medulloblastoma using paediatric protocols.
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.
Spreafico
Filippo
F
Paediatric Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy. filippo.spreafico@institutotumori.mi.it
Massimino
Maura
M
Gandola
Lorenza
L
Cefalo
Graziella
G
Mazza
Elena
E
Landonio
Giuseppe
G
Pignoli
Emanuele
E
Poggi
Geraldina
G
Terenziani
Monica
M
Pedrazzoli
Paolo
P
Siena
Salvatore
S
Fossati-Bellani
Franca
F
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
D014750:Vincristine; D008130:Lomustine; D008727:Methotrexate