title: Reappraisal of clinical outcome in adult medulloblastomas with emphasis on patterns of relapse.
abstract: BACKGROUND
  Clinical outcome and prognostic factors were assessed in adult medulloblastoma patients, with emphasis on patterns of relapse.
  
  
  METHODS
  Records of 36 consecutive adult patients with medulloblastoma were reviewed. Patients were classified into 2 prognostic groups according to the extent of disease and quality of surgical excision based on the early postoperative magnetic resonance imaging (MRI) findings. Standard-risk (SR) patients (n = 11) received postoperative craniospinal radiation therapy (RT) only, 36 Gy, 1.8 Gy per daily fraction, with a 18 Gy boost to the posterior cerebral fossa (PCF). High-risk (HR) patients (n = 25) received additional adjuvant chemotherapy.
  
  
  RESULTS
  With a median follow-up of 46 months (range 5-155), 19 patients experienced tumour relapse. Sites of relapse(s) included tumour bed in 6 patients, resulting in a PCF control of 83.4%. Three-year overall survival (OS) and progression-free survival (PFS) were 67.3% and 57.4%, respectively. The comparison of the HR and SR populations demonstrated significant differences in OS (p = 0.005) and PFS (p = 0.001). Quality of surgical excision and extent of disease beyond the PCF were predictive factors for OS (p = 0.04, p = 0.001, respectively) and PFS (p = 0.004, and p = 0.02, respectively).
  
  
  CONCLUSIONS
  The quality of resection was a significant prognostic factor, suggesting that surgery should be as extensive as possible. Systematic postoperative MRI allowed accurate selection of SR patients for whom RT alone was enough to obtain high local control. Every effort should be made to avoid RT disruption. Increased delay led to worse outcome.
authors: Department of Radiation Oncology, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, France.
authors: Cyrus
authors: C
authors: Chargari
authors: Loïc
authors: L
authors: Feuvret
authors: Antonin
authors: A
authors: Levy
authors: Ionnis
authors: I
authors: Lamproglou
authors: Avi
authors: A
authors: Assouline
authors: Charles
authors: C
authors: Hemery
authors: Lilia
authors: L
authors: Ghorbal
authors: Stephane
authors: S
authors: Lopez
authors: Bernadette
authors: B
authors: Tep
authors: Gilbert Boisserie
authors: GB
authors: G
authors: Philippe
authors: P
authors: Lang
authors: Florence
authors: F
authors: Laigle-Donadey
authors: Philippe
authors: P
authors: Cornu
authors: Jean-Jacques
authors: JJ
authors: Mazeron
authors: Jean-Marc
authors: JM
authors: Simon
mesh_terms: D000293:Adolescent; D000328:Adult; D002528:Cerebellar Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000379:methods; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008527:Medulloblastoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D018714:Radiotherapy, Adjuvant / Q000379:methods; D055815:Young Adult