Prognostic Factors, Complication, and Patterns of Relapse in Adult Medulloblastoma

Abstract

Objectives This study aimed to determine the outcome of a management policy for adult medulloblastoma and to evaluate the impact of proposed prognostic factors on the outcome. Patients and Methods The study included 15 adult patients; 9 males and 6 females with mean age of 25.5±9.3 years and had newly diagnosed; biopsy-confirmed medulloblastoma confined to the craniospinal axis. There were 11 lateral and 4 midline lesions and 12 patients had hydrocephalus. Headache, and nausea and vomiting were the commonest presenting symptoms with a mean duration of symptoms of 6.1±3 weeks. All patients underwent brain MRI; brain CT scan for 5 patients and spinal evaluations was conducted. All patients underwent surgical resection followed by external-beam radiotherapy to the entire craniospinal axis and 7 patients had chemotherapy. Regular follow-up visits for clinical and radiological assessment were designed. Results Patients having hydrocephalus underwent ventricular shunt procedures prior to surgical resection. Total resection was feasible in 8 patients, subtotal resection in 4, and partial resection in 2 patients. One patient had only biopsy and resection was infeasible. Radiotherapy was initiated after a mean duration of 40±20 days after surgery and the median duration of radiotherapy was a 60±20.5 day. The mean duration of follow-up was 36±18; range: 6 to 72 months. Five patients had experienced recurrences after mean duration of follow-up of 18±12.5 months; 3 recurrences were in the surgical beds and 2 as bone metastasis. Three patients had recurrence died with a 3-year relapse-free of 66.7%, the 3-year morbidity secondary to recurrence was 13.3% with a 3-year mortality rate of 20%. There was a negative significant correlation between possibility of relapse and the extent of surgical resection and was found as a specific predictor for relapse-free postoperative course. Conclusions The assumed policy of surgical resection, as much as possible, followed by radio and chemotherapy was appropriate therapeutic modality for adult medulloblastoma with 3-year relapse-free life of 66.7%. The extent of surgical resection was found as a specific predictor for prognosis after such treatment policy.