ATPS-71EFFICACY OF TEMOZOLOMIDE IN AN ADULT WITH MEDULLOBLASTOMA, REVIEW OF SERIES OF TWO PATIENTS

Abstract

Medulloblastoma is a malignant CNS tumor which is essentially a disease of childhood. It occurs infrequently in adults accounting for less than 1% of all intracranial tumors in adults. Due to the relative infrequency in adults, the clinical characteristics of this disease are not well defined in adults in comparison to children, and optimal treatment is not well established. Complete tumor resection with CSI radiation is the standard of care for treatment of adult medulloblastoma. In contrast to childhood medulloblastoma, the role of chemotherapy in adult population is undetermined. A number of chemotherapy agents in treatment of pediatric medulloblastoma have been evaluated and used including vincristine, CCNU, cisplatin, carboplatin, and cyclophosphamide. We report a case series of two patients diagnosed with medulloblastoma who underwent surgical resection followed by radiation therapy. Both patients underwent 24 cycles of chemotherapy with temozolamide over a period of 2 years with minimal toxicity. They were monitored with multiple MRIs of brain which have not revealed any disease recurrence so far rendering one patient disease free for eight and a half years and the other for six months. Very few cases of medulloblastoma treated with temozolamide have been reported. Our case series shows the antitumor effect of temozolamide in treatment of medulloblastoma with minimal toxicity. Most of the literature is based on retrospective analysis rather than randomized studies due to the small number of adult cases reported with this disease compared to the pediatric population. The optimal treatment regimen is not well established for this tumor and because of its rarity a multi-institutional clinical trial will be necessary to define the best treatment.