The Prognosis of Medulloblastoma in Children

Abstract

The te rm medul lob las toma was introduced to distinguish this neoplasm as a specific tumor ent i ty by Bailey and Cushing in 19~5. 8 Cushing had opera ted upon tumors of this type as early as 1903. TM Bailey and Cushing believed tha t a fa ta l outcome was inevitable, but t ha t radiat ion t h e r a p y was conclusively beneficial in prolonging the average postoperat ive survival. 9 This me thod of t reat m e n t had been used since 1919.19 Not ing an incidence of 6 cases of spinal meningeal metas tases among their to ta l of 61, they extended the field of irradiat ion to include routinely the spinal axis in 19~72 Thei r goal of operat ion was to unblock the aqueduct , ra ther than to a t t e m p t gross total removal of the t umor? 9 Subsequent repor t s have been in substantial agreement wi th the ear ly views of Bailey and Cushing regarding t r e a t m e n t and prognosis 1 0 -12 ,16 ,18 ,25 ,29-31 ,38 ,43 ,46 ,51 ,54-56 The futi l i ty of a t t e m p t i n g cure by radical operat ion has become well establ ished? 2 On the other hand, i r radiat ion wi thout operat ion has been condemned. I r reparab le damage m a y occur during the delay necessitated by trial irradiation of a radioresis tant , benign tumor incorrectly diagnosed2 7 Fur thermore , irradiation wi thout pr ior decompression risks a fatal edema. 17 The possible advan tage of avoiding operat ive dissemination of t u m o r cells through the subarachnoid space has assumed less importance since it has been shown tha t seeding may occur even wi thout operation?,~3 Survivals longer than 5 years have been repor ted sporadical]y?4,17,20-24,2~-2s,32,34-~6,40, 41,4~-49,6z,sa In some of these cases the diagnosis has been disputed or actual ly changed. 7, 12,17,57 The m a t t e r is fur ther complicated by the failure of m a n y authors to confine their reports to tumors occurring in children, 14,17, 20,21,24,26,27,32,;~4,36,47-49,53 since similar tumors in the adul t have been thought to have a more favorable prognosisN ,5~ Bailey believes t h a t the medul loblas toma occurs only in children under 15 and tha t the leptomeningeal sarcoma has often been confused with it in the adult . 5 While this m a y be a m a t t e r of opinion, we feel t h a t analyses clearly distinguishing between cases in children and in adul ts are more meaningful. The most optimist ic repor t o ther t han our own is tha t of Pa te rson and F a r r ? 5 In 1953 they repor ted 6 children with 5-year survivals among ~1 opera ted upon and irradiated.