Long-term Outcomes and Role of Chemotherapy in Adults With Newly Diagnosed Medulloblastoma

Abstract

Objective To assess the survival and role of adjuvant chemotherapy in adult medulloblastoma. Methods We reviewed outcomes of 66 patients (aged 18 y or more; median age, 33 y) with medulloblastoma. Forty-four (67%) patients had M0 disease, 9 had M1-M4, and 13 had MX. Thirty-one patients each for whom risk stratification was available were classified as high risk or standard risk. Fifty-six patients had histologic results: classic histology was the most common (n = 46 [84%]), followed by desmoplastic (n = 9), and large cell/anaplastic (n = 1). Overall survival (OS) and progression-free survival (PFS) were estimated with Kaplan-Meier curves and log-rank tests. Cox regression analysis was used to compare recurrences. Results Median follow-up was 6.7 years. The estimated 5-year OS and PFS were 74% and 59%, respectively. High-risk versus standard-risk classification was associated with worse OS (61% vs. 86%; P = 0.03) and recurrence (hazard ratio, 2.56; P = 0.05) and a trend for worse PFS (49% vs. 69%; P = 0.13). Gross total resection was associated with improved OS (P = 0.03) and a trend toward improved PFS (P = 0.09). No chemotherapy benefit could be demonstrated for the group as a whole. For high-risk patients with classic histology (n = 25), chemotherapy was associated with a trend for improvement in 5-year PFS from 36% to 71% (P = 0.10) and in 5-year OS from 49% to 100% (P = 0.08). Conclusions In adult patients with medulloblastoma, the extent of resection and risk classification predicts the outcome. These results suggest a chemotherapy benefit for high-risk patients with classic histology.

Telovelar approach to pediatric fourth ventricle tumors: feasibility and outcome.

“…We found that PFS and OS were better in patients who had GTR (p=0.020), patients without CSF metastasis (p<0.001), and in the SR group of MB patients (p=0.005). This was also reported in other series (3,7,13,23).…”

Adjuvant chemotherapy and overall survival in adult medulloblastoma

“…7,17,18 Call et al demonstrated a nonsignificant trend for improved survival with chemotherapy, but only in adults with high-risk MB (n = 66). 6 The ability to evaluate adjuvant chemotherapy based on the available data is limited by small sample sizes and heterogeneous populations and chemotherapy regimens. Additionally, many patients in these studies did not receive regimens containing cisplatin, an agent that is currently used commonly and is associated with improved disease control in pediatric MB.…”

“…There are no randomized trials investigating the benefit of chemotherapy in adult MB, and evidence is generally limited to small retrospective series reported over several decades with conflicting results. [6][7][8][9] Furthermore, compared with children, adults may suffer less toxicity from CSI and greater morbidity from chemotherapy. This may lead to hesitancy in using postoperative chemotherapy, …”

Adolescents and young adults with brain tumors in the context of molecular advances in neuro‐oncology

“…This low recruitment was likely due to poorer tolerance of the postradiation chemotherapy and retrospective data supporting that surgery and 36 Gy of craniospinal irradiation with a posterior fossa boost yield a satisfactory 60–70% 5‐year OS . This approach in adults results in overall poorer outcomes and an increased frequency of extraneural metastases compared to children . The need of adjuvant chemotherapy is stressed by findings in a recent large retrospective study, where analogous to children, the addition of chemotherapy to radiation conferred a survival benefit.…”

“…92 This approach in adults results in overall poorer outcomes and an increased frequency of extraneural metastases compared to children. 93 The need of adjuvant chemotherapy is stressed by findings in a recent large retrospective study, where analogous to children, the addition of chemotherapy to radiation conferred a survival benefit.…”