Medulloblastoma in adults: clinical characteristics and treatment

• Published in: Cancer treatment reviews Vol. 25; no. 1; pp. 3 - 12
• Main Authors: Brandes, A.A., Palmisano, V., Monfardini, S.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.02.1999; Elsevier
• Subjects: Actuarial Analysis; Adolescent; Adult; adults; Aged; Antineoplastic agents; Biological and medical sciences; Cerebellar Neoplasms - mortality; Cerebellar Neoplasms - pathology; Cerebellar Neoplasms - therapy; Chemotherapy; Chemotherapy, Adjuvant; Combined Modality Therapy; Cranial Irradiation; follow-up; Humans; Medical sciences; Medulloblastoma; Medulloblastoma - mortality; Medulloblastoma - pathology; Medulloblastoma - therapy; Middle Aged; Neoplasm Recurrence, Local - mortality; pathology; Pharmacology. Drug treatments; Premedication; Prognosis; radiotherapy; Radiotherapy, Adjuvant; recurrences; Retrospective Studies; review; Salvage Therapy; Survival Analysis; Survival Rate; therapy; Treatment Outcome; recurrences; follow-up; pathology; Medulloblastoma; therapy; review; adults; radiotherapy; chemotherapy; Antineoplastic agent; Human; Nervous system diseases; Relapse; Prognosis; Neurospongioma; Adjuvant treatment; Malignant tumor; Review; Radiotherapy; Malignant glioma; Treatment; Surgery; Central nervous system disease; Diagnosis; Predictive factor
• ISSN: 0305-7372; 1532-1967
• DOI: 10.1053/ctrv.1998.0096

Long-term survival is possible in adults with medulloblastoma with rates of approximately 50–60% at 5 years, and 40–50% at 10 years. As the literature data are based on retrospective studies, treatments are neither randomized nor uniform, however, some treatment cornerstones have been identified. The first step is surgery, which should be as radical as possible; adjuvant radiotherapy must be 55 Gy on the posterior fossa, and 36 Gy on the remaining cranial-spinal axis; adjuvant chemotherapy may be useful in patients at high risk of recurrence provided it is administered before radiotherapy in moderate-high dosages and includes cisplatin, etoposide and cyclophosphamide. This chemotherapy program should not overly delay the start of radiotherapy, be recycled as soon as blood count permits and not exceed two or three cycles. Adjuvant chemotherapy after radiotherapy, even if indicated in cases with persistent tumour, may have an adverse effect due to the poor marrow reserves of these patients. At recurrence, the prospects of cure are very poor due to the deficient hematopoietic reserve, but in very young patients high dose chemotherapy with marrow rescue might be usefully employed.