Etoposide-carboplatin association as 'emergency' up-front chemotherapy in a case of life-threatening adult medulloblastoma.

Medulloblastoma is a rare tumor in the adult population. Current therapies include surgery and irradiation. Unlike in children, chemotherapy is not commonly used, and its potential has poorly been investigated to date. We report the case of an adult patient with disseminated medulloblastoma and fulminant neurological deterioration, precluding craniospinal irradiation. Emergency chemotherapy consisting of carboplatin (400 mg/m2) and etoposide (500 mg/m2) with intrathecal (i.t.) administration of cytosar and hydrocortisone was initiated. Impressive clinical response was achieved after the first cycle of chemotherapy, with the complete disappearance of the lesions detected by MRI. After 3 courses of chemotherapy, the patient underwent craniospinal irradiation (36 Gy to the entire neuraxis and 54 Gy to the posterior fossa). Two years after surgery, the patient was well, with complete clinical recovery, and a new MRI confirmed the disappearance of the lesions. Given the dramatic efficacy of the etoposide-carboplatin association (combined with i.t. cytosar), this regimen has to be considered in an emergency setting and seems to be a very attractive candidate to be investigated as first line therapy for poor risk medulloblastoma in adults.