Overall Management > Embryonal Tumors | Staging and Prognosis | Treatment > Carboplatin · Etoposide · Lomustine · Methotrexate · Vincristine  

Meeting Abstract

Survival results in adults treated for medulloblastoma

F. Spreafico, M. Massimino, L. Gandola, S. Siena, G. Cefalo, E. Mazza, P. Versari, G. Landonio, P. Pedrazzoli, F. Fossati-Bellani

Istituto Nazionale per lo Studio e la Cura dei Tumori, Milan, Italy; Ospedale Niguarda Ca' Granda, Milan, Italy; San Raffaele, Milan, Italy

A retrospective record review of 22 medulloblastoma pts older than 18 yrs treated adopting pediatric protocols in closely-collaborating Institutions, between 1987 and 2002, has been performed: median age 24 yrs (range, 18.4-41.1), m:f ratio 1:1.
19 pts underwent gross total resection, 3 subtotal.
5 pts had metastases: nodular spinal seeding in 4, positive CSF cytology in 1.
Adjuvant treatment consisted of one of two regimens, depending on the historical period, followed by craniospinal irradiation (CSI) plus local boost:
regimen A (n=12): VCR, intrathecal or/and i.v. MTX, 36 Gy CSI and 55 Gy to posterior fossa, and VCR/lomustine as a maintenance (Cancer 1984; 54:1956-1961);
or regimen B (n=8): dose-intensive CT sequencing MTX 8 g/m2, VP16 2.4 g/m2, CTX 4 g/m2, CBDCA 800 mg/m2, plus VCR 1.4 mg/m2, hyperfractionated-accelerated radiotherapy (HART) (39 Gy to neuraxis, 60 Gy to posterior fossa), VCR/lomustine maintenance.
2 pts were given only up-front conventional CSI and maintenance CT.
At a median f-up of 51 mos (range, 15-164) 8 pts, 7 treated with regimen A, relapsed.
All the 8 pts entered into dose-intensive B study are alive disease-free, seven being relapse-free.
Median time to relapse was 36 mos.
None of the 4 Chang stage T3M3 pts, all receiving the regimen B, suffered events at median 22 mos (range, 15-57).
One of these latter pts received further HD-thiotepa and PBSC rescue.
The interval between surgery and RT was 118 days median for regimen B and 53 days for regimen A.
Regimen B-related myelotoxicity was manageable and never life-threatening.
HART was completed as planned in all but 1 pt, due to thrombocytopenia.
For the whole series the 5-yr EFS and S by Kaplan-Meier method are 58% and 67%, respectively; 48% and 58%, respectively, at 10 yrs.
Even with the limit of the small pts number we consider 'sandwich' sequential high-dose CT in combination with HART, a valid treatment option for medulloblastoma in adults and this approach seems to overcome previously-recognized risk factors.

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