title: Adjuvant chemotherapy in adult medulloblastoma: is it an option for average-risk patients?
abstract: The standard treatment in children with average-risk medulloblastoma (MB) is reduced-dose radiotherapy (RT) followed by chemotherapy. However, in adults, there is no agreement on the use of adjuvant chemotherapy. We performed a retrospective analysis of adult MB patients with average-risk disease, defined as no postsurgical residual (or ≤1.5 cm(2)) and no metastatic disease (M0). Main inclusion criteria were: age >16 years, post-surgical treatment with craniospinal irradiation with or without adjuvant chemotherapy (cisplatin and etoposide ± cyclophosphamide). From 1988 to 2012 were accrued 43 average-risk MB patients treated with surgery and adjuvant RT. Fifteen (34.9 %) patients received also chemotherapy: 7 before RT, 5 after RT, and 3 before and after RT. Reasons to administer chemotherapy were presence of residual disease (even if ≤1.5 cm) and delay in RT. After a median follow up time of 10 years (range: 8-13), median survival was 18 years (95 % CI 9-28) in patients who receive RT alone, and was not reached in patients treated with RT plus chemotherapy. The survival rates at 5, 10 and 15 years were 100 %, 78.6 % (95 % CI 60.0-97.2 %) and 60.2 % (95 % CI 36.9-83.5 %), in patients treated with RT alone, and 100, 100 and 100 %, in patients treated with RT plus chemotherapy (p = 0.079). Our findings suggest a role for adjuvant chemotherapy in the treatment of average-risk MB adult patients. Further improvements might drive to add chemotherapy in average-risk setting with less favourable biological signatures (i.e., non-WNT group).
authors.affiliation: Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Franceschi
authors.affiliation: Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Bartolotti
authors.affiliation: Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Paccapelo
authors.affiliation: Section of Pathology "M. Malpighi", Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Marucci
authors.affiliation: Department of Neuroradiology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Agati
authors.affiliation: Department of Neuroscience and Neurosurgery, San Bortolo Hospital, Viale Rodolfi, 37, 36100, Vicenza, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Volpin
authors.affiliation: Pathology Department, San Bortolo Hospital, Viale Rodolfi, 37, 36100, Vicenza, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Danieli
authors.affiliation: Pathology Department, Verona Hospital, P.le A. Stefani 1, 37126, Verona, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Ghimenton
authors.affiliation: Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University Hospital, Via Giustiniani, 1, 35121, Padua, Italy.
authors.forename: M P
authors.initials: MP
authors.lastname: Gardiman
authors.affiliation: Department of Neurosurgery, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Sturiale
authors.affiliation: Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Poggi
authors.affiliation: Department of Radiotherapy Unit, CRO, Via Franco Gallini, 233081, Aviano, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Mascarin
authors.affiliation: Department of Radiotherapy, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Balestrini
authors.affiliation: Department of Neurosurgery, Verona Hospital, P.le A. Stefani 1, 37126, Verona, Italy.
authors.forename: B
authors.initials: B
authors.lastname: Masotto
authors.affiliation: Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy. alba.brandes@yahoo.it.
authors.forename: A A
authors.initials: AA
authors.lastname: Brandes
mesh_terms: D000293:Adolescent; D000328:Adult; D002528:Cerebellar Neoplasms / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008527:Medulloblastoma / Q000628:therapy*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D055815:Young Adult
keywords: Adults; Average risk; Chemotherapy; Medulloblastoma; Radiotherapy