title: Distinctive clinical course and pattern of relapse in adolescents with medulloblastoma.
abstract: OBJECTIVE
  To report the clinical course of adolescents with medulloblastoma, with specific emphasis on prognosis and pattern of relapse.
  
  
  METHODS
  We retrospectively studied the clinical course and outcomes of children aged 10-20 years with medulloblastoma, treated at centers throughout Canada between 1986 and 2003. To better assess time to relapse, a cohort of patients aged 3-20 years at diagnosis was generated.
  
  
  RESULTS
  A total of 72 adolescents were analyzed. Five-year overall survival and event-free survival rates were 78.3%+/-5.4% and 68.0%+/-6.2%, respectively. Late relapses occurred at a median of 3.0 years (range, 0.3-6.8 years). In univariate analysis, conventional risk stratification and the addition of chemotherapy to craniospinal radiation did not have prognostic significance. Female patients had improved overall survival (p=0.007). Time to relapse increased with age in a linear fashion. After relapse, patients faired poorly regardless of treatment modality. Patients who did not receive chemotherapy initially had improved progression-free survival at relapse (p=0.05).
  
  
  CONCLUSIONS
  Our study suggests that adolescents with medulloblastoma might have a unique prognosis and pattern of relapse, dissimilar to those in younger children. They might benefit from different risk stratifications and prolonged follow-up. These issues should be addressed in future prospective trials.
authors.affiliation: Pediatric Brain Tumor Program, The Hospital for Sick Children, Toronto, and Department of Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada. uri.tabori@sickkids.ca
authors.forename: Uri
authors.initials: U
authors.lastname: Tabori
authors.forename: Lillian
authors.initials: L
authors.lastname: Sung
authors.forename: Juliette
authors.initials: J
authors.lastname: Hukin
authors.forename: Normand
authors.initials: N
authors.lastname: Laperriere
authors.forename: Bruce
authors.initials: B
authors.lastname: Crooks
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Carret
authors.forename: Mariana
authors.initials: M
authors.lastname: Silva
authors.forename: Isaac
authors.initials: I
authors.lastname: Odame
authors.forename: Chris
authors.initials: C
authors.lastname: Mpofu
authors.forename: Douglas
authors.initials: D
authors.lastname: Strother
authors.forename: Beverly
authors.initials: B
authors.lastname: Wilson
authors.forename: Yvan
authors.initials: Y
authors.lastname: Samson
authors.forename: Eric
authors.initials: E
authors.lastname: Bouffet
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000704:Analysis of Variance; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy; D002648:Child; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary; D009364:Neoplasm Recurrence, Local / Q000401:mortality*; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012737:Sex Factors