Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA, USA.
J Clin Neurosci. 2020 Jun;76:154-160. doi: 10.1016/j.jocn.2020.04.002. Epub 2020 Apr 11.
Adult medulloblastoma is rare, and management is extrapolated from pediatric cases. This investigation evaluated the prognostic role of chemotherapy (and sequencing thereof), the degree of resection, and craniospinal irradiation (CSI) dose.
The National Cancer Database was queried for adult (age ≥18) medulloblastoma. Resection was coded as gross (GTR) or subtotal resection (STR) or biopsy only; concurrent chemoradiotherapy (CRT) was defined as receipt within 14 days of each other. Statistics included Kaplan-Meier overall survival (OS) analysis and Cox proportional hazards modeling.
Of 1144 patients, 613 had coded surgical information; 242 (39%) did not undergo surgery, 277 (45%) underwent STR, and 94 (15%) had GTR. A total of 428 (37.4%) did not receive chemotherapy, 348 (30.4%) received sequential CRT, and 368 (32.2%) underwent concurrent CRT. Of the 711 patients with CSI dose information, 202 (28.4%) received 23-30 Gy CSI and 509 (71.6%) patients received 30-36 Gy. Median follow-up was 56.5 months. Extent of resection did not correlate with 10-year OS (74.2% biopsy only, 72.7% STR, 82.2% GTR, p > 0.05 all comparisons) or on Cox multivariate analysis. Chemotherapy was associated with higher OS (65.6% vs. 51.2%, p = 0.035) and a trend towards significance on multivariate assessment (p = 0.082). Sequencing of chemotherapy and CSI dose were not associated with OS (p > 0.05 for both).
Although causation cannot be implied, neither the extent of resection nor CSI dose associated with OS in adult medulloblastoma. Chemotherapy could have utility in higher-risk patients; concurrent administration may not be beneficial, especially given therapy-induced neuro-cognitive sequelae.
成人髓母细胞瘤较为罕见，其治疗方法多从儿科病例中推断得出。本研究评估了化疗（及其顺序）、切除程度和全脑脊髓照射（CSI）剂量的预后作用。
从国家癌症数据库中检索成人（年龄≥18 岁）髓母细胞瘤患者数据。切除程度编码为大体全切除（GTR）、次全切除（STR）或仅活检；同期放化疗（CRT）定义为在彼此 14 天内接受治疗。统计分析包括 Kaplan-Meier 总生存（OS）分析和 Cox 比例风险模型。
在 1144 例患者中，有 613 例患者的手术信息被编码；242 例（39%）未接受手术，277 例（45%）行 STR，94 例（15%）行 GTR。共有 428 例（37.4%）未接受化疗，348 例（30.4%）接受序贯 CRT，368 例（32.2%）接受同期 CRT。在 711 例接受 CSI 剂量信息的患者中，202 例（28.4%）接受 23-30Gy CSI，509 例（71.6%）接受 30-36Gy CSI。中位随访时间为 56.5 个月。切除范围与 10 年 OS 无相关性（仅活检 74.2%，STR 72.7%，GTR 82.2%，所有比较均 p>0.05）或多变量分析（p=0.082）。化疗与较高的 OS 相关（65.6% vs. 51.2%，p=0.035），且在多变量评估中呈显著趋势（p=0.082）。化疗顺序和 CSI 剂量与 OS 均无相关性（p>0.05）。
尽管不能暗示因果关系，但成人髓母细胞瘤的切除程度和 CSI 剂量均与 OS 无关。化疗可能对高危患者有用；同期治疗可能无益，特别是考虑到治疗引起的神经认知后遗症。
