title: Adult medulloblastoma: multiagent chemotherapy with cisplatinum and etoposide: a single institutional experience.
abstract: In 1991, a prospective phase II trial was initiated to evaluate the efficacy of treatment for adults with medulloblastoma (MB). After surgery, patients were staged with a neuroradiologic examination of the brain and neuroaxis and by cerebrospinal fluid cytology. All patients received three cycles of upfront cisplatinum (cisplatinum) and etoposide (VP16) chemotherapy followed by cranio-spinal radiation therapy. The current article reports on the long-term results from that trial. After a median follow-up of 14.9 years, among a total of 28 adults with MB, the overall progression-free survival and overall survival (OS) rates at 5 years were 57.6 and 80%, respectively. The median OS for the whole group of patients was 11.3 years. The observed toxicity was mainly hematological, with leukopenia and thrombocytopenia (16% of grades 3 and 4). In summary, in our small series of patients, the role of combination administration of CDDP + VP16 started before the initiation of radiotherapy in reducing recurrences, particularly distant recurrences, remains unclear. To know whether adding chemotherapy to craniospinal radiation in adult therapy increases relapse-free and overall survival, we must await the results of a larger randomized controlled clinical trial.
authors.affiliation: Department of Neuro-oncology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. silvani@istituto-besta.it
authors.forename: A
authors.initials: A
authors.lastname: Silvani
authors.forename: P
authors.initials: P
authors.lastname: Gaviani
authors.forename: E
authors.initials: E
authors.lastname: Lamperti
authors.forename: A
authors.initials: A
authors.lastname: Botturi
authors.forename: F
authors.initials: F
authors.lastname: Dimeco
authors.forename: A
authors.initials: A
authors.lastname: Franzini
authors.forename: P
authors.initials: P
authors.lastname: Ferroli
authors.forename: L
authors.initials: L
authors.lastname: Fariselli
authors.forename: I
authors.initials: I
authors.lastname: Milanesi
authors.forename: A
authors.initials: A
authors.lastname: Erbetta
authors.forename: B
authors.initials: B
authors.lastname: Pollo
authors.forename: A
authors.initials: A
authors.lastname: Salmaggi
mesh_terms: D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D002945:Cisplatin / Q000008:administration & dosage*; D005047:Etoposide / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy; D008875:Middle Aged; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D005047:Etoposide; D002945:Cisplatin