Franceschi E, Bartolotti M, Paccapelo A, Marucci G, Agati R, Volpin L, Danieli D, Ghimenton C, Gardiman M P, Sturiale C, Poggi R, Mascarin M, Balestrini D, Masotto B, Brandes A A
Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
Section of Pathology "M. Malpighi", Bellaria-Maggiore Hospitals, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy.
J Neurooncol. 2016 Jun;128(2):235-40. doi: 10.1007/s11060-016-2097-x. Epub 2016 Mar 3.
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).
平均风险髓母细胞瘤（MB）患儿的标准治疗是减量放疗（RT）后进行化疗。然而，对于成人MB患者辅助化疗的使用尚无共识。我们对平均风险疾病的成人MB患者进行了回顾性分析，平均风险疾病定义为术后无残留（或≤1.5 cm²）且无转移性疾病（M0）。主要纳入标准为：年龄>16岁，术后接受全脑全脊髓照射，联合或不联合辅助化疗（顺铂和依托泊苷±环磷酰胺）。1988年至2012年期间，共有43例接受手术和辅助放疗的平均风险MB患者入组。15例（34.9%）患者还接受了化疗：7例在放疗前，5例在放疗后，3例在放疗前后均接受化疗。进行化疗的原因是存在残留疾病（即使≤1.5 cm）以及放疗延迟。中位随访时间为10年（范围：8 - 13年），单纯接受放疗的患者中位生存期为18年（95% CI 9 - 28），接受放疗加化疗的患者未达到中位生存期。单纯接受放疗的患者5年、10年和15年生存率分别为100%、78.6%（95% CI 60.0 - 97.2%）和60.2%（95% CI 36.9 - 83.5%），接受放疗加化疗的患者5年、10年和15年生存率分别为100%、100%和100%（p = 0.079）。我们的研究结果表明辅助化疗在平均风险MB成年患者的治疗中具有一定作用。进一步的改进可能促使在生物学特征不太有利的平均风险情况下（即非WNT组）增加化疗。
