Treatment and prognosis of medulloblastoma--a study of 13 surgical cases (author's transl)

Abstract

Thirteen cases of medulloblastoma were experienced. All of the patients were operated on and the diagnosis was confirmed histologically. Nine were then treated with cranial and spinal irradiation. Three patients received incomplete irradiation and one died without it. A one year-old and a 14 year-old boys among the nine patients with completed scheduled irradiation showed no recurrence or metastasis; the former for seven years and four months and the latter for five years. In the other seven cases, five had local recurrences and six had spinal metastasis. Four of these patients also showed second recurrences and/or metastasis. There were three spinal, one frontal, one extracranial metastases and two local recurrences. Recurrences and/or metastases in three of these seven cases were aggressively treated with re-irradiation and combined-chemotherapy (vincristine, procarbazine and predonisolone, including methtrexate occasionally). Patients with recurrence and/or metastasis after one year or with survival times of more than three years were found to be older, had radical operations and received less primary dosis in the posterior fossa and a higher dosis in the spinal canal, compared with patients with early recurrence and/or metastasis or with short survival periods. Three patients who received re-irradiation and combined chemotherapy and one patient who was treated with antibiotics for meningitis are alive at present. It was clear that not only the age of patients and operative procedures, but the spinal irradiation dosis influenced the time of recurrence or metastasis and survival. Primary spinal irradiation doses were below 2, 500 rads in seven of the nine cases who completed initial cranial and scheduled spinal irradiation. It seems that a low dosis in the spinal canal decreased the survival rate compared with those in other institutions using higher spinal doses. Complete irradiation of the entire CNS at certain doses (whole brain: 4, 000-5, 000 rads, posterior fossa: 4, 500-5, 000 rads, and spinal: 3, 000-3, 500 rads) and early postoperative chemotherapy are recommended, and aggressive treatment including re-operation, re-irradiation and long term combined-chemotherapy is indispensable to combat recurrence and metastasis.