Prognostic factors after extraneural metastasis of medulloblastoma.
OBJECTIVE
To review the existing literature regarding the characteristics, prognostic factors, treatment, and survival of patients with medulloblastoma, who develop extraneural metastasis (ENM).


METHODS
A PubMed search of English language articles from 1961 to 2007 was performed, yielding 47 articles reporting on 119 patients. Factors analyzed included age, time interval to development of ENM, ENM location, central nervous system (CNS) involvement, treatment, and outcome.


RESULTS
Sites of ENM included bone in 84% of patients, bone marrow in 27% of patients, lymph nodes in 15% of patients, lung in 6% of patients, and liver in 6% of patients. Median survival was 8 months after diagnosis of ENM. The 1-, 2-, and 5-year overall survival (OS) rates after diagnosis of ENM were 41.9%, 31.0%, and 26.0%, respectively. The 1-, 2-, and 5-year progression-free survival (PFS) rates after diagnosis of ENM were 34.5%, 23.2%, and 13.4%, respectively. For patients without CNS involvement at the time of ENM diagnosis, the 1-, 2-, and 5-year OS rates for those treated with and without radiotherapy (RT) were 82.4%, 64.8%, and 64.8% vs. 51.0%, 36.6%, and 30.5%, respectively (p = 0.03, log-rank test). RT did not significantly improve OS or PFS rates for those with CNS involvement. Concurrent CNS involvement, ENM in the lung or liver, a time interval of <18 months to development of ENM, and a patient age of <16 years at ENM diagnosis were found to be negative prognostic factors for both OS and PFS.


CONCLUSIONS
Several prognostic factors were identified for patients with ENM from medulloblastoma. Patients without concurrent CNS involvement, who received RT after ENM diagnosis had an OS and PFS benefit compared to those who did not receive RT.
Department of Radiology, Section of Radiation Oncology, The Methodist Hospital, Houston, Texas 77030, USA.
Ali
A
Mazloom
Azy H
AH
Zangeneh
Arnold C
AC
Paulino
D000293:Adolescent; D000328:Adult; D000368:Aged; D019046:Bone Marrow Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D001859:Bone Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D016543:Central Nervous System Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D002528:Cerebellar Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy; D008207:Lymphatic Metastasis; D008297:Male; D008527:Medulloblastoma / Q000401:mortality / Q000556:secondary* / Q000628:therapy; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate; D055815:Young Adult