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A
prospective study on medulloblastoma (MB) in adults
Alba A Brandes, Mario Ermani, Pietro Amista,
Umberto Basso, Francesca Vastola, Antonino Rotilio, Carlo Mazza, Franco
Ammannati, Bianca Guglielmi, Franco Berti
Azienda Ospedale-Universita, Padova, Italy;
Azienda Ospedale-Universita, Verona, Italy; Azienda Ospedale-Universita, Firenze,
Italy; Azienda Ospedale, Vicenza, Italy
Background.
MB is uncommon in adults, and prospective trials have not been performed to
date.
Objectives. To evaluate time to progression (TTP) and survival (OS) of
adult patients (pts) with MB staged according to Chang's system and extent of
surgery (R).
Methods. Eligibility criteria were age
≥ 18 years and histological diagnosis of MB; all pts were staged pre-operatively
by craniospinal MRI and CSF cytology.
Low Risk (LR) pts were T1-2,T3a, M-, and
no residual disease (R-), High Risk (HR) T3-4, or M+ or R+;
Treatment Plan LR
pts were treated with radiotherapy only (36 Gy craniospinal dose plus 18 Gy
boost to posterior fossa (PF).
HR pts received 2 cycles of up-front chemotherapy
(DDP 25 mg/m2 + VP-16 40 mg/m2 day 1 to 4,
Cyclophosphamide 1g/m2 on day 4, recycling every 4 weeks), followed
by the same radiotherapy.
Maintenance chemotherapy with the same regimen was
delivered in M+ pts for 4 more cycles or up to complete remission.
Patients. 41
pts were eligible (75% males), and 36 are now evaluable.
Median age was 26 yr
(range 18-57), MB was classic in 22 pts (61%) and median in 20 (55.5%); 22 pts
(61%) presented hydrocephalus.
After a median follow-up of 3.7 yr (range
0.6-13), 12 pts (33%) relapsed, 4 in the PF, 2 supratentorial, 3 spinal, 1 only
in CSF, and 2 in bone marrow.
Results.
Median TTP was 81 mo, 5y-EFS was 65.4%;
median OS was 97.8 mo and 5 y-OS was 75.3%. M+ patients obtained a 5y-EFS of 45
vs 75% in M- (p=0.01) and a 5y-OS of 51 vs 87% in M- (p=0.01).
Residual disease
was not prognostic neither for 5y-EFS (60% in R+ vs 79% in R-) nor for 5y-OS
(68% vs 90%).
26 HR pts achieved 5y-EFS and 5y-OS of 61 and 68% vs 76 and 89% in
LR pts.
Conclusions.
Large, multicenter and prospective trials are needed to
delineate the best prognostic factors and optimal treatment in adult MB.
© Copyright 2002 American Society of Clinical Oncology
Source:
http://www.asco.org/ac/1,1003,_12-002636-00_18-0016-00_19-00301,00.asp |
