Chargari Cyrus, Feuvret Loïc, Levy Antonin, Lamproglou Ionnis, Assouline Avi, Hemery Charles, Ghorbal Lilia, Lopez Stephane, Tep Bernadette, G Gilbert Boisserie, Lang Philippe, Laigle-Donadey Florence, Cornu Philippe, Mazeron Jean-Jacques, Simon Jean-Marc
Department of Radiation Oncology, Groupe Hospitalier Pitié Salpêtrière, Assistance Publique des Hôpitaux de Paris, France.
Br J Neurosurg. 2010 Aug;24(4):460-7. doi: 10.3109/02688691003739881.
Clinical outcome and prognostic factors were assessed in adult medulloblastoma patients, with emphasis on patterns of relapse.
Records of 36 consecutive adult patients with medulloblastoma were reviewed. Patients were classified into 2 prognostic groups according to the extent of disease and quality of surgical excision based on the early postoperative magnetic resonance imaging (MRI) findings. Standard-risk (SR) patients (n = 11) received postoperative craniospinal radiation therapy (RT) only, 36 Gy, 1.8 Gy per daily fraction, with a 18 Gy boost to the posterior cerebral fossa (PCF). High-risk (HR) patients (n = 25) received additional adjuvant chemotherapy.
With a median follow-up of 46 months (range 5-155), 19 patients experienced tumour relapse. Sites of relapse(s) included tumour bed in 6 patients, resulting in a PCF control of 83.4%. Three-year overall survival (OS) and progression-free survival (PFS) were 67.3% and 57.4%, respectively. The comparison of the HR and SR populations demonstrated significant differences in OS (p = 0.005) and PFS (p = 0.001). Quality of surgical excision and extent of disease beyond the PCF were predictive factors for OS (p = 0.04, p = 0.001, respectively) and PFS (p = 0.004, and p = 0.02, respectively).
The quality of resection was a significant prognostic factor, suggesting that surgery should be as extensive as possible. Systematic postoperative MRI allowed accurate selection of SR patients for whom RT alone was enough to obtain high local control. Every effort should be made to avoid RT disruption. Increased delay led to worse outcome.
对成年髓母细胞瘤患者的临床结局和预后因素进行了评估，重点关注复发模式。
回顾了36例连续的成年髓母细胞瘤患者的记录。根据术后早期磁共振成像（MRI）结果，根据疾病范围和手术切除质量将患者分为2个预后组。标准风险（SR）患者（n = 11）仅接受术后颅脊髓放射治疗（RT），36 Gy，每日分次剂量1.8 Gy，对后颅窝（PCF）追加18 Gy。高风险（HR）患者（n = 25）接受额外的辅助化疗。
中位随访46个月（范围5 - 155个月），19例患者出现肿瘤复发。复发部位包括6例患者的肿瘤床，PCF控制率为83.4%。三年总生存率（OS）和无进展生存率（PFS）分别为67.3%和57.4%。HR组和SR组的比较显示，OS（p = 0.005）和PFS（p = 0.001）存在显著差异。手术切除质量和PCF以外的疾病范围是OS（分别为p = 0.04，p = 0.001）和PFS（分别为p = 0.004和p = 0.02）的预测因素。
切除质量是一个重要的预后因素，表明手术应尽可能广泛。系统性术后MRI允许准确选择仅接受RT就足以获得高局部控制的SR患者。应尽一切努力避免放疗中断。延迟增加导致预后更差。
