title: Long-term outcomes and role of chemotherapy in adults with newly diagnosed medulloblastoma.
abstract: OBJECTIVE
  To assess the survival and role of adjuvant chemotherapy in adult medulloblastoma.
  
  
  METHODS
  We reviewed outcomes of 66 patients (aged 18 y or more; median age, 33 y) with medulloblastoma. Forty-four (67%) patients had M0 disease, 9 had M1-M4, and 13 had MX. Thirty-one patients each for whom risk stratification was available were classified as high risk or standard risk. Fifty-six patients had histologic results: classic histology was the most common (n=46 [84%]), followed by desmoplastic (n=9), and large cell/anaplastic (n=1). Overall survival (OS) and progression-free survival (PFS) were estimated with Kaplan-Meier curves and log-rank tests. Cox regression analysis was used to compare recurrences.
  
  
  RESULTS
  Median follow-up was 6.7 years. The estimated 5-year OS and PFS were 74% and 59%, respectively. High-risk versus standard-risk classification was associated with worse OS (61% vs. 86%; P=0.03) and recurrence (hazard ratio, 2.56; P=0.05) and a trend for worse PFS (49% vs. 69%; P=0.13). Gross total resection was associated with improved OS (P=0.03) and a trend toward improved PFS (P=0.09). No chemotherapy benefit could be demonstrated for the group as a whole. For high-risk patients with classic histology (n=25), chemotherapy was associated with a trend for improvement in 5-year PFS from 36% to 71% (P=0.10) and in 5-year OS from 49% to 100% (P=0.08).
  
  
  CONCLUSIONS
  In adult patients with medulloblastoma, the extent of resection and risk classification predicts the outcome. These results suggest a chemotherapy benefit for high-risk patients with classic histology.
authors.affiliation: *Department of Radiation Oncology ‡Division of Anatomic Pathology §Division of Biomedical Statistics and Informatics ∥Division of Medical Oncology ¶Department of Neurologic Surgery, Mayo Clinic, Rochester, MN †Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Call
authors.forename: Mihir
authors.initials: M
authors.lastname: Naik
authors.forename: Fausto J
authors.initials: FJ
authors.lastname: Rodriguez
authors.forename: Caterina
authors.initials: C
authors.lastname: Giannini
authors.forename: Wenting
authors.initials: W
authors.lastname: Wu
authors.forename: Jan C
authors.initials: JC
authors.lastname: Buckner
authors.forename: Ian F
authors.initials: IF
authors.lastname: Parney
authors.forename: Nadia N
authors.initials: NN
authors.lastname: Laack
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002528:Cerebellar Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015192:Infratentorial Neoplasms / Q000175:diagnosis; D053208:Kaplan-Meier Estimate; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome