Sherwood Marissa, Climans Seth, Ramos Ronald, Laperriere Normand J, Gao Andrew F, Millar Barbara-Ann, Shultz David B, Tsang Derek S, Mason Warren P
Department of Radiation Oncology, University of Toronto, Toronto, Ontario M5T 1P5, Canada.
Radiation Medicine Program, Princess Margaret Cancer Centre, University Health Network (UHN), Toronto, Ontario M5G 2M9, Canada.
Neurooncol Pract. 2022 Sep 18;10(2):186-194. doi: 10.1093/nop/npac074. eCollection 2023 Apr.
The historic standard of care for adult medulloblastoma has been considered surgery and radiation, while chemotherapy is increasingly being prescribed. This study reviewed 20-year chemotherapy trends at a high-volume center, as well as overall and progression free-survival.
Adults with medulloblastoma treated at an academic center from January 1, 1999 to -December 31, 2020 were reviewed. Patient baseline data were summarized and Kaplan-Meier estimators were used for survival.
Forty-nine patients were included; median age was 30 years and male: female ratio was 2:1. Desmoplastic and classical histologies were most common. Of all patients, 23 (47%) were high risk and 7 (14%) metastatic at diagnosis. Only 10 (20%) received initial chemotherapy, of which 70% were high risk and 30% metastatic, with most treated from 2010 to 2020. Forty percent of initial chemotherapy patients received salvage chemotherapy for recurrence or metastases (of all patients, 49% required salvage). Initial chemotherapy regimens were mainly cisplatin/lomustine/vincristine, and at recurrence cisplatin/etoposide. Median overall survival was 8.6 years (95% CI 7.5-∞), with 1-, 5-, and 10-year survival at 95.8%, 72%, and 46.7%. Median overall survival for those who did not receive initial chemotherapy was 12.4 years and 7.4 years for those who did (-value .2).
Twenty years of adult medulloblastoma treatment was reviewed. Initial chemotherapy patients, most of whom were high risk, trended towards worse survival, but this was nonsignificant. The ideal timing and choice of chemotherapy for adult medulloblastoma is unknown-challenges of administering chemotherapy following photon craniospinal irradiation may have prevented it from becoming routine.
成神经管细胞瘤成人患者的传统治疗标准一直被认为是手术和放疗，而化疗的应用也越来越普遍。本研究回顾了一家大型中心20年来的化疗趋势，以及总生存期和无进展生存期。
回顾了1999年1月1日至2020年12月31日在一家学术中心接受治疗的成神经管细胞瘤成人患者。总结了患者的基线数据，并使用Kaplan-Meier估计法计算生存率。
纳入49例患者；中位年龄为30岁，男女比例为2:1。促纤维增生型和经典组织学类型最为常见。所有患者中，23例（47%）为高危患者，7例（14%）在诊断时已有转移。仅10例（20%）接受了初始化疗，其中70%为高危患者，30%已有转移，大多数患者在2010年至2020年期间接受治疗。40%的初始化疗患者因复发或转移接受了挽救性化疗（所有患者中，49%需要挽救性化疗）。初始化疗方案主要为顺铂/洛莫司汀/长春新碱，复发时为顺铂/依托泊苷。中位总生存期为8.6年（95%CI 7.5-∞），1年、5年和10年生存率分别为95.8%、72%和46.7%。未接受初始化疗患者的中位总生存期为12.4年，接受初始化疗患者的中位总生存期为7.4年（P值.2）。
回顾了20年的成神经管细胞瘤成人治疗情况。初始化疗患者大多为高危患者，生存趋势较差，但差异无统计学意义。成神经管细胞瘤成人患者化疗的理想时机和选择尚不清楚——光子颅脊柱照射后进行化疗的挑战可能使其未能成为常规治疗方法。
