title: Radiotherapy for adult medulloblastoma: Long term result from a single institution. A review of prognostic factors and why we do need a multi-institutional cooperative program.
abstract: OBJECTIVE
  We retrospectively analyzed our Institution experience with these patients. The endpoints of the analysis were overall survival (OS), disease-free survival (DFS), local control (LC), metastasis free survival (MFS); results were compared with the literature.
  
  
  BACKGROUND
  Medulloblastoma in adult patients is a very rare disease; the 5 and 10-year overall survival rates range between 33-78% and 27-56%, respectively. The collection of more clinical data is strongly needed.
  
  
  METHODS
  From September 1975 to October 2006, we treated 16 adult patients (9 males and 7 females) with a histological diagnosis of medulloblastoma. Acute and late toxicities were scored according to RTOG toxicity scale. Karnofski performance status (KPS) and neurological performance status (NPS) pre- and post-RT were reported. Median age was 27 years (range 18-53 years). All the patients received cranio-spinal irradiation, two patients were also given chemotherapy. Median follow-up period was 121.5 months.
  
  
  RESULTS
  In January 2014, 10/16 patients were alive without evidence of disease, 6/16 died with progressive disease (1 local and spinal, 3 spinal and 2 extraneural). Ten-year LC, OS, DFS, MFS were, respectively, 84%, 67%, 60% and 59%. Univariate analysis shows that gross total resection is associated with better survival. No acute or late G3-G4 toxicity was observed.
  
  
  CONCLUSIONS
  This experience and the analysis of the literature confirm the efficacy of postoperative RT but also the need of large datasets to better define prognostic factors and the possible role of the association of chemotherapy.
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Ghirardelli
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Triggiani
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Pedretti
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Pasinetti
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Berardino
authors.initials: B
authors.lastname: De Bari
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Tonoli
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Borghetti
authors.affiliation: Medical Physics, Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Spiazzi
authors.affiliation: Radiation Oncology Department, Brescia University and Spedali Civili - Brescia, Brescia, Italy.
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Magrini
keywords: Adult medulloblastoma; Chemotherapy; Cranio-spinal irradiation