Abstract
BackgroundMedulloblastoma is extremely rare in adults. The role of chemotherapy for average-risk adult patients remains controversial. Surgery and radiotherapy provide a significant disease control and a good prognosis, but about 25% of average-risk patients have a relapse and die because of disease progression. No data in average-risk adult patients are available to compareradiotherapy alone and radiotherapyfollowed byadjuvant chemotherapy.MethodsWe analyzed 48 average-risk patients according to Chang classification diagnosed from 1988 to 2016.ResultsMedian age was 29 years (range 16–61). Based on histological subtypes, 15 patients (31.3%) had classic, 15 patients (31.3%) had desmoplastic, 5 patients (10.4%) had extensive nodularity and 2 patients (4.2%) had large cells/anaplastic medulloblastoma. Twenty-four patients (50%) received adjuvant radiotherapy alone and 24 (50%) received radiotherapy and chemotherapy. After a median follow-up of 12.5 years, we found that chemotherapyincreases progression-free survival (PFS-15 82.3 ± 8.0% in patients treated with radiotherapy and chemotherapyvs. 38.5% ± 13.0% in patients treated with radiotherapy alone p = 0.05) and overall survival (OS-15 89.3% ± 7.2% vs. 52.0% ± 13.1%, p = 0.02). Among patients receiving chemotherapy, the reported grade ≥ 3 adverse events were: 9 cases of neutropenia (6 cases of G3 neutropenia [25%] and 3 cases of G4 neutropenia [13%]), 1 case of G3 thrombocytopenia (4%) and 2 cases of G3 nausea (8%).ConclusionsOur study with a long follow up period suggests that adding adjuvant chemotherapy to radiotherapy might improve PFS and OS in average-risk adult medulloblastoma patients.
Highlights
The patients were homogeneously distributed on two groups: 24 (50%) received only adjuvant radiotherapy and 24 (50%) received chemotherapy
We found that adding chemotherapy increased Progression-free survival (PFS) (HR 0.334; 95% CI 0.105– 1.068, p = 0.05)
In the present study with more patients and a longer follow up time we showed a statistically significant survival benefit from adding chemotherapy in terms of Overall survival (OS) and PFS (p = 0.05 for PFS and 0.02 for OS)
Summary
Surgery and radiotherapy provide a significant disease control and a good prognosis, but about 25% of average-risk patients have a relapse and die because of disease progression. No data in average-risk adult patients are available to compareradiotherapy alone and radiotherapyfollowed byadjuvant chemotherapy. Medulloblastoma is rare in adults (less than 1% of primitive CNS tumors) with an incidence of 0.6–1 case per million per year [1,2,3]. Correct staging is an important prognostic factor by influencing therapeutic program. Fundamental staging examinations are brain/spinal MRI before and after The average-risk group presents no metastasis (M0) and no residual disease after surgery (residual disease has been defined > 1.5 cm 2). The role of chemotherapy for average-risk adult patients remains controversial. There are no data if adding chemotherapy to radiotherapy improves the results
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