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.
*Department of Radiation Oncology
‡Division of Anatomic Pathology
§Division of Biomedical Statistics and Informatics
∥Division of Medical Oncology
¶Department of Neurologic Surgery, Mayo Clinic, Rochester, MN
†Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL
Presented at the American Society for Therapeutic Radiology and Oncology 52nd Annual Meeting, San Diego, CA, October 31-November 4, 2010.
The authors declare no conflicts of interest.
Reprints: Nadia N. Laack, MD, Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail: email@example.com.