Outcomes of adult medulloblastoma treated with a multimodality approach: A tertiary cancer center experience

Supriya Mallick; Ajeet Kumar Gandhi; Rony Benson; Daya Nand Sharma; Kunhi Parambath Haresh; Subhash Gupta; Pramod Kumar Julka; Goura Kisor Rath

doi:10.4103/2278-330X.175954

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NEURO ONCOLOGY : Original Article

04 (

); 174-178

doi:

10.4103/2278-330X.175954

Outcomes of adult medulloblastoma treated with a multimodality approach: A tertiary cancer center experience

Supriya Mallick¹, Ajeet Kumar Gandhi^1,, Rony Benson¹, Daya Nand Sharma¹, Kunhi Parambath Haresh¹, Subhash Gupta¹, Pramod Kumar Julka¹, Goura Kisor Rath¹

1 Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi

*Corresponding author: Dr. Ajeet Kumar Gandhi. ajeetgandhi23@gmail.com

Published: 2020-12-31

MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Objectives: Adult medulloblastoma (AMB) is a rare central nervous system tumor. We aimed to analyze the treatment outcomes of AMB treated at our institute with surgery followed by craniospinal irradiation (CSI) and adjuvant chemotherapy. Methods: We retrospectively evaluated the treatment charts of 31 patients of AMB treated from 2003-2011. The patient demography, treatment details and survival data were collected in a predesigned proforma. Kaplan Meier method was used to analyze disease free survival (DFS) and the impact of prognostic factors was determined by univariate analysis (log rank test). Results: Male: Female ratio was 21:10. Cerebrospinal fluid dissemination was noted in 16% cases. CSI (36 Gray at 1.8 Gray/fraction to entire neuraxis and 20 Gray at 2 Gray/fraction boost to posterior fossa) was used in all cases. 26 patients received adjuvant chemotherapy (carboplatin plus etoposide). Median follows up was 26.85 months (9.47-119.73 months). The estimated 3 and 5 years DFS was found to be 84.9% and 50.7% respectively. On univariate analysis, tumor located laterally had a trend towards better DFS (HR 3.04; 95%CI 0.722 to 12.812; P = 0.07) compared to midline tumors. Other factors like adjuvant chemotherapy, age, gender, surgical extent had no statistically significant impact on survival. Conclusion: The results of our study (largest series from India) show that the regimen of surgery, adjuvant CSI and chemotherapy is feasible and confers descent survival. AMB patients should be treated with a multimodality approach in a tertiary care centre.

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References

Spreafico F, Massimino M, Gandola L, Cefalo G, Mazza E, Landonio G, et al. Survival of adults treated for medulloblastoma using paediatric protocols. Eur J Cancer 2005;41:1304-10.
Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB. Cancer Incidence in Five Continents. Vol. VIII. Lyon: International Agency for Research on Cancer; 2002.
Remke M, Hielscher T, Northcott PA, Witt H, Ryzhova M, Wittmann A, et al. Adult medulloblastoma comprises three major molecular variants. J Clin Oncol 2011;29:2717-23.
Padovani L, Sunyach MP, Perol D, Mercier C, Alapetite C, Haie-Meder C, et al. Common strategy for adult and pediatric medulloblastoma: A multicenter series of 253 adults. Int J Radiat Oncol Biol Phys 2007;68:433-40.
Greenberg HS, Chamberlain MC, Glantz MJ, Wang S. Adult medulloblastoma: Multiagent chemotherapy. Neuro Oncol 2001;3:29-34.
Brandes AA, Franceschi E, Tosoni A, Reni M, Gatta G, Vecht C, et al. Adult neuroectodermal tumors of posterior fossa (medulloblastoma) and of supratentorial sites (stPNET). Crit Rev Oncol Hematol 2009;71:165-79.
Chang CH, Housepian EM, Herbert C Jr. An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas. Radiology 1969;93:1351-9.
Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 1990;8:1277-80.
Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97-109.
Bloom HJ, Bessell EM. Medulloblastoma in adults: A review of 47 patients treated between 1952 and 1981. Int J Radiat Oncol Biol Phys 1990;18:763-72.
Carrie C, Lasset C, Blay JY, Négrier S, Bouffet E, Barbet N, et al. Medulloblastoma in adults: Survival and prognostic factors. Radiother Oncol 1993;29:301-7.
Tabori U, Sung L, Hukin J, Laperriere N, Crooks B, Carret AS, et al. Distinctive clinical course and pattern of relapse in adolescents with medulloblastoma. Int J Radiat Oncol Biol Phys 2006;64:402-7.
Chan AW, Tarbell NJ, Black PM, Louis DN, Frosch MP, Ancukiewicz M, et al. Adult medulloblastoma: Prognostic factors and patterns of relapse. Neurosurgery 2000;47:623-31.
Weil MD, Lamborn K, Edwards MS, Wara WM. Influence of a child′s sex on medulloblastoma outcome. JAMA 1998;279:1474-6.
Brandes AA, Ermani M, Amista P, Basso U, Vastola F, Gardiman M, et al. The treatment of adults with medulloblastoma: A prospective study. Int J Radiat Oncol Biol Phys 2003;57:755-61.
Ferrante L, Mastronardi L, Celli P, Acqui M, Cervoni L, Fortuna A. Medulloblastoma in adulthood. J Neurosurg Sci 1991;35:23-30.
Hubbard JL, Scheithauer BW, Kispert DB, Carpenter SM, Wick MR, Laws ER Jr. Adult cerebellar medulloblastomas: The pathological, radiographic, and clinical disease spectrum. J Neurosurg 1989;70:536-44.
del Charco JO, Bolek TW, McCollough WM, Maria BL, Kedar A, Braylan RC, et al. Medulloblastoma: Time-dose relationship based on a 30-year review. Int J Radiat Oncol Biol Phys 1998;42:147-54.
Berry MP, Jenkin RD, Keen CW, Nair BD, Simpson WJ. Radiation treatment for medulloblastoma. A 21-year review. J Neurosurg 1981;55:43-51.
Hazuka MB, DeBiose DA, Henderson RH, Kinzie JJ. Survival results in adult patients treated for medulloblastoma. Cancer 1992;69:2143-8.
Thomas PR, Deutsch M, Kepner JL, Boyett JM, Krischer J, Aronin P, et al. Low-stage medulloblastoma: Final analysis of trial comparing standard-dose with reduced-dose neuraxis irradiation. J Clin Oncol 2000;18:3004-11.
Packer RJ, Gajjar A, Vezina G, Rorke-Adams L, Burger PC, Robertson PL, et al. Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol 2006;24:4202-8.
Silvani A, Gaviani P, Lamperti E, Botturi A, Dimeco F, Franzini A, et al. Adult medulloblastoma: Multiagent chemotherapy with cisplatinum and etoposide: A single institutional experience. J Neurooncol 2012;106:595-600.
Kunschner LJ, Kuttesch J, Hess K, Yung WK. Survival and recurrence factors in adult medulloblastoma: The M.D. Anderson Cancer Center experience from 1978 to 1998. Neuro Oncol 2001;3:167-73.
Menon G, Krishnakumar K, Nair S. Adult medulloblastoma: Clinical profile and treatment results of 18 patients. J Clin Neurosci 2008;15:122-6.
Gandhi R, Babu R, Cummings TJ, Adamson C. Adult primitive neuroectodermal tumors: The prognostic value of supratentorial location. J Neurooncol 2013;114:141-8.

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[1] Spreafico F, Massimino M, Gandola L, Cefalo G, Mazza E, Landonio G, et al. Survival of adults treated for medulloblastoma using paediatric protocols. Eur J Cancer 2005;41:1304-10.

[2] Parkin DM, Whelan SL, Ferlay J, Teppo L, Thomas DB. Cancer Incidence in Five Continents. Vol. VIII. Lyon: International Agency for Research on Cancer; 2002.

[3] Remke M, Hielscher T, Northcott PA, Witt H, Ryzhova M, Wittmann A, et al. Adult medulloblastoma comprises three major molecular variants. J Clin Oncol 2011;29:2717-23.

[4] Padovani L, Sunyach MP, Perol D, Mercier C, Alapetite C, Haie-Meder C, et al. Common strategy for adult and pediatric medulloblastoma: A multicenter series of 253 adults. Int J Radiat Oncol Biol Phys 2007;68:433-40.

[5] Greenberg HS, Chamberlain MC, Glantz MJ, Wang S. Adult medulloblastoma: Multiagent chemotherapy. Neuro Oncol 2001;3:29-34.

[6] Brandes AA, Franceschi E, Tosoni A, Reni M, Gatta G, Vecht C, et al. Adult neuroectodermal tumors of posterior fossa (medulloblastoma) and of supratentorial sites (stPNET). Crit Rev Oncol Hematol 2009;71:165-79.

[7] Chang CH, Housepian EM, Herbert C Jr. An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas. Radiology 1969;93:1351-9.

[8] Macdonald DR, Cascino TL, Schold SC Jr, Cairncross JG. Response criteria for phase II studies of supratentorial malignant glioma. J Clin Oncol 1990;8:1277-80.

[9] Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Burger PC, Jouvet A, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97-109.

[10] Bloom HJ, Bessell EM. Medulloblastoma in adults: A review of 47 patients treated between 1952 and 1981. Int J Radiat Oncol Biol Phys 1990;18:763-72.

[11] Carrie C, Lasset C, Blay JY, Négrier S, Bouffet E, Barbet N, et al. Medulloblastoma in adults: Survival and prognostic factors. Radiother Oncol 1993;29:301-7.

[12] Tabori U, Sung L, Hukin J, Laperriere N, Crooks B, Carret AS, et al. Distinctive clinical course and pattern of relapse in adolescents with medulloblastoma. Int J Radiat Oncol Biol Phys 2006;64:402-7.

[13] Chan AW, Tarbell NJ, Black PM, Louis DN, Frosch MP, Ancukiewicz M, et al. Adult medulloblastoma: Prognostic factors and patterns of relapse. Neurosurgery 2000;47:623-31.

[14] Weil MD, Lamborn K, Edwards MS, Wara WM. Influence of a child′s sex on medulloblastoma outcome. JAMA 1998;279:1474-6.

[15] Brandes AA, Ermani M, Amista P, Basso U, Vastola F, Gardiman M, et al. The treatment of adults with medulloblastoma: A prospective study. Int J Radiat Oncol Biol Phys 2003;57:755-61.

[16] Ferrante L, Mastronardi L, Celli P, Acqui M, Cervoni L, Fortuna A. Medulloblastoma in adulthood. J Neurosurg Sci 1991;35:23-30.

[17] Hubbard JL, Scheithauer BW, Kispert DB, Carpenter SM, Wick MR, Laws ER Jr. Adult cerebellar medulloblastomas: The pathological, radiographic, and clinical disease spectrum. J Neurosurg 1989;70:536-44.

[18] del Charco JO, Bolek TW, McCollough WM, Maria BL, Kedar A, Braylan RC, et al. Medulloblastoma: Time-dose relationship based on a 30-year review. Int J Radiat Oncol Biol Phys 1998;42:147-54.

[19] Berry MP, Jenkin RD, Keen CW, Nair BD, Simpson WJ. Radiation treatment for medulloblastoma. A 21-year review. J Neurosurg 1981;55:43-51.

[20] Hazuka MB, DeBiose DA, Henderson RH, Kinzie JJ. Survival results in adult patients treated for medulloblastoma. Cancer 1992;69:2143-8.

[21] Thomas PR, Deutsch M, Kepner JL, Boyett JM, Krischer J, Aronin P, et al. Low-stage medulloblastoma: Final analysis of trial comparing standard-dose with reduced-dose neuraxis irradiation. J Clin Oncol 2000;18:3004-11.

[22] Packer RJ, Gajjar A, Vezina G, Rorke-Adams L, Burger PC, Robertson PL, et al. Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol 2006;24:4202-8.

[23] Silvani A, Gaviani P, Lamperti E, Botturi A, Dimeco F, Franzini A, et al. Adult medulloblastoma: Multiagent chemotherapy with cisplatinum and etoposide: A single institutional experience. J Neurooncol 2012;106:595-600.

[24] Kunschner LJ, Kuttesch J, Hess K, Yung WK. Survival and recurrence factors in adult medulloblastoma: The M.D. Anderson Cancer Center experience from 1978 to 1998. Neuro Oncol 2001;3:167-73.

[25] Menon G, Krishnakumar K, Nair S. Adult medulloblastoma: Clinical profile and treatment results of 18 patients. J Clin Neurosci 2008;15:122-6.

[26] Gandhi R, Babu R, Cummings TJ, Adamson C. Adult primitive neuroectodermal tumors: The prognostic value of supratentorial location. J Neurooncol 2013;114:141-8.

Outcomes of adult medulloblastoma treated with a multimodality approach: A tertiary cancer center experience

Abstract

Abstract

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