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Long-term outcomes of adult medulloblastoma patients treated with radiotherapy.

TitleLong-term outcomes of adult medulloblastoma patients treated with radiotherapy.
Publication TypeJournal Article
Year of Publication2018
AuthorsDe B, Beal K, De Braganca KC, Souweidane MM, Dunkel IJ, Khakoo Y, Gilheeney SW, DeAngelis LM, Menzel P, Patel SH, Wolden SL
JournalJ Neurooncol
Volume136
Issue1
Pagination95-104
Date Published2018 Jan
ISSN1573-7373
KeywordsAdolescent, Adult, Aged, Cerebellar Neoplasms, Disease Progression, Female, Humans, Kaplan-Meier Estimate, Male, Medulloblastoma, Middle Aged, Treatment Outcome, Young Adult
Abstract

Medulloblastoma (MB) is rare in adults and treatment guidelines are consequently not well-established. Few modern series have reported long-term follow-up and treatment sequelae. We examined long-term outcomes of adult MB patients at one institution. Records of 29 consecutive patients (18 male, 11 female) aged ≥ 18 years who received radiotherapy (RT) for primary MB from 1990 to 2016 were reviewed. Median age at diagnosis was 28 years (range 18-72 years). Seventeen patients were standard risk and 12 were high risk. Nineteen patients had gross total resection, seven had subtotal resection, and three had biopsy only. Median craniospinal irradiation and boost doses were 36 Gy (range 23.4-39.6 Gy) and 55.8 Gy (range 54-59.4 Gy), respectively. Of 24 patients receiving chemotherapy, 20 received concurrent + adjuvant and 4 received adjuvant only. At median follow-up of 9.0 years (range 1.1-20.5 years), five patients recurred: four in the posterior fossa and one in both the posterior fossa and above the tentorium. Five patients died: two of disease progression and three after possible treatment complications (seizure, lobar pneumonia, and multifactorial sepsis). At last follow-up, 23 patients were alive with no evidence of disease. Long-term effects include executive dysfunction (n = 17), weakness/ataxia (n = 16), and depression/anxiety (n = 13). Kaplan-Meier estimates of 10-year overall survival and failure-free survival are 83% (95% confidence interval [CI] 59-93%) and 79% (CI 55-91%), respectively. Despite encouraging disease control in this cohort, long-term sequelae may limit quality of life. Multimodality pediatric regimens using lower RT doses may be considered to reduce treatment-related morbidity.

DOI10.1007/s11060-017-2627-1
Alternate JournalJ Neurooncol
PubMed ID29019042
PubMed Central IDPMC5918279
Grant ListP30 CA008748 / CA / NCI NIH HHS / United States
P30 CA008748 / / The National Institutes of Health/National Cancer Institute Cancer Center Support Grant /