title: Adult medulloblastoma: clinical characters, prognostic factors, outcomes and patterns of relapse.
abstract: To analyze the clinical characters, prognostic factors, patterns of relapse and treatment outcomes for medulloblastoma in adults. The clinical materials of 73 consecutive adult patients (age, ≥16 years) with medulloblastoma were analyzed retrospectively. Follow-up data were available in 62 patients, ranging from 10 to 142 months (median, 78.4 months). Outcome in survival was assessed by the progression-free survival (PFS) and overall survival (OS). Univariate and multivariate analysis were performed to determine the prognostic factors. Total or near-total tumor resection was achieved in 37 cases (59.7 %), subtotal in 19 cases (30.6 %), and partial resection in 6 cases (9.7 %).Twenty-two patients experienced recurrences, and 45 % percent of all recurrences occurred more than 4 years after initial surgery. The PFS rates at 5 and 8 years were 60.1 and 37.0 %, respectively. The OS rates at 5 and 8 years were 82.6 and 57.3 %, respectively. In univariate analysis, less tumor resection, non-desmoplastic pathology, and brainstem involvement were risk factors for worse PFS and OS (P < 0.05). High-risk category was associated with just lower PFS, but not OS. In multivariate analysis, complete resection and desmoplastic pathology were independently predictive factors of improved PFS and OS. In adult medulloblastoma, late relapse is common and therefore long-term follow-up is important for evaluating the real impact of treatments. Risk category had prognostic value just for PFS, but not for OS. Complete resection and desmoplastic histology are independently predictive factors for favorable outcomes.
authors.affiliation: Department of Neurology, Tongji Hospital, Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, Hubei, China.
authors.forename: Na
authors.initials: N
authors.lastname: Zhang
authors.affiliation: Department of Neurosurgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Taohui
authors.initials: T
authors.lastname: Ouyang
authors.affiliation: Department of Neurology, Tongji Hospital, Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, Hubei, China.
authors.forename: Huicong
authors.initials: H
authors.lastname: Kang
authors.affiliation: Department of Neurosurgery, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Wang
authors.initials: W
authors.lastname: Long
authors.affiliation: Department of Neurosurgery, Port Moresby General Hospital, University of Papua New Guinea, Port Moresby, Papua New Guinea.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Thomas
authors.affiliation: Department of Neurology, Tongji Hospital, Huazhong University of Science and Technology, Jiefang Avenue No. 1095, Wuhan, 430030, Hubei, China. husttjzh110@163.com.
authors.forename: Suiqiang
authors.initials: S
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000187:drug effects / Q000473:pathology / Q000528:radiation effects / Q000601:surgery; D001932:Brain Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D059248:Chemoradiotherapy / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008527:Medulloblastoma / Q000175:diagnosis / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D019635:Neurosurgical Procedures / Q000009:adverse effects; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adult; Chemotherapy; Medulloblastoma; Posterior fossa