Adult medulloblastoma: Multiagent chemotherapy

Abstract

In this study, the records of 17 adult patients with medulloblastoma treated with craniospinal radiation and 1 of 2 multiagent chemotherapy protocols were reviewed for progression-free survival, overall survival, and toxicity, and the patients were compared with each other and with similarly treated children and adults. Records of patients treated at 3 institutions were reviewed. Seventeen medulloblastoma patients (11 female, 6 male) with a median age of 23 years (range, 18-47 years) were treated with surgery, craniospinal radiation (CSRT) plus local boost, and 1 of 2 adjuvant chemotherapy regimens. All tumors were infratentorial (10 in 4th ventricle and 7 in left or right hemisphere). Ten patients presented with hydrocephalus, and 7 of them were shunted. Eight patients had gross total resection, 7 had subtotal resection (>50% removed), and 2 had partial resection (<50% removed). Postoperatively, 3 patients had positive cytology and 3 had positive spinal MRI. Five patients were classi ed as good risk and 12 were classi ed as poor risk (Chang staging system). Ten patients were treated with the "Packer protocol," consisting of CSRT plus weekly vincristine followed by 8 cycles of cisplatin, lomustine, and vincristine. Seven patients were treated with the Pediatric Oncology Group (POG) protocol, consisting of alternating courses of cisplatin/etoposide and cyclophosphamide/vincristine, followed by CSRT. Eight of 17 patients relapsed, with all 8 relapsing at the primary site. Other relapse sites included the leptomeninges (5), bone (1), and brain (1). The estimated median relapse-free survival (Kaplan-Meier) for all patients was 48 months (95% con dence interval, >26 months to ¥). Median relapse-free survival for patients on the Packer protocol was 26 months, and for those on the POG regimen was 48 months (P = 0.410). Five of 10 on the Packer protocol were relapse-free, while 4 of 7 were relapse-free on the POG regimen. Two patients relapsed during chemotherapy and 6 relapsed after completing all therapy at 18, 18, 26, 30, 40, and 48 months. The estimated median survival of all patients was 56 months (95% con dence interval, 27 to ¥) with 11 patients alive; for the Packer protocol, median survival was 36 months, and for the POG protocol, it was 57 months (P = 0.058). The hazard ratio was 0 (95% con dence interval, 0 to ¥). Toxicity during the Packer protocol was moderately severe, with only 1 of 10 patients able to complete all therapy. Two patients had severe abdominal pain during CSRT + vincristine, and 5 had peripheral neuropathy during vincristine therapy. Hearing loss (>20 dB) occurred in 7, neutropenia (<500 µl) in 6, thrombocytopenia (<50,000 µl) in 6, nephrotoxicity (>25% ¯by creatinine clearance) in 2, and decreased pulmonary function (diffusing capacity for carbon monoxide ¯>40%) in 1. On the POG protocol, only 1 patient had persistent nausea and vomiting, 2 had peripheral neuropathy, and 3 had hearing de cit (>20 dB) or tinnitus. The POG and Packer protocols did not have a statistically signi cant differenc...

Survival and prognostic factors in a series of adults with medulloblastomas

“…1,4,10,22,31,32,38,40 The distribution of histological variants was also comparable to that reported by other authors, 1,7,10,19,24,26,31,34,36,38,43 with predominance of the classic histological phenotype. However, our population showed some characteristics different from other series.…”

Gender‐specific activity of chemotherapy correlates with outcomes in chemosensitive cancers of young adulthood

“…[9][10][11] An important recent retrospective analysis by 22 This study demonstrated that both increasing age and male gender were associated with significantly less toxicity using VIDE chemotherapy. In HL, females were reported to experience both greater toxicity and better survival than males, and the degree of neutropenia correlated with eventual outcome.…”

“…[6][7][8] Survival has been linked to treatment on paediatric protocols, 4 or to treatment at specialized paediatric centers. 6 It has been widely speculated that clinicians believe that adults tolerate treatment less well than children, [9][10][11] and chemotherapy dose intensity in adult acute lymphoblastic leukaemia (ALL) protocols was lower than in paediatric protocols. 4 Other contributing factors may include delayed clinical presentation and compliance issues.…”

Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs)

“…In 2000, Greenberg et al noted in a series of 17 adults that adults had higher rates of toxicity from chemotherapy, and 100% of adults required dose reductions during their course of treatment compared with 4.4% of children who were unable to complete treatment. 30,31 Thus, different treatment protocol and other unrecorded variables may be the source of the differences observed in this study.…”