Brandes Alba A, Ermani Mario, Amista Pietro, Basso Umberto, Vastola Francesca, Gardiman Marina, Iuzzolino Paolo, Turazzi Sergio, Rotilio Antonino, Volpin Lorenzo, Mazza Carlo, Sainati Laura, Ammannati Franco, Berti Franco
Department of Medical Oncology, Azienda Ospedale-Università of Padova, Padova, Italy.
Int J Radiat Oncol Biol Phys. 2003 Nov 1;57(3):755-61. doi: 10.1016/s0360-3016(03)00643-6.
To assess in a prospective trial the value of prognostic factors and the outcome of medulloblastoma in adults.
Patients (> or =18 years) with a histologic diagnosis of medulloblastoma were staged according to Chang et al.'s classification (low risk: T1, T2, T3a, M0, and no residual disease after surgery; high risk: T3b-T4, any M+ or postoperative presence of residual tumor). In low-risk patients, treatment consisted of 36 Gy to the craniospinal axis, supplemented by a local tumor dose of 18.8 Gy (total dose of 54.8 Gy). In high-risk patients, 2 cycles of "up-front chemotherapy" were delivered before the same radiation therapy, followed by maintenance chemotherapy if M1, M2, or M3 disease was present.
Over a 12-year period, 36 evaluable patients were enrolled. Progression-free survival (PFS) at 5 years was higher in low-risk patients compared to the high-risk group: 76% +/- 14% (95% confidence interval [CI] = 52%-100%) vs. 61% +/- 11% (95% CI = 42%-87%). Patients with M- disease showed a significantly better outcome than M+ patients, with 75% showing PFS at 5 years vs. 45% (p = 0.01).
The overall PFS observed is comparable to that obtained in pediatric series and suggests that a more effective therapy must be developed for high-risk patients.
