Long-term outcomes of adult medulloblastoma patients treated with radiotherapy Journal Article

Authors: De, B.; Beal, K.; De Braganca, K. C.; Souweidane, M. M.; Dunkel, I. J.; Khakoo, Y.; Gilheeney, S. W.; DeAngelis, L. M.; Menzel, P.; Patel, S. H.; Wolden, S. L.
Article Title: Long-term outcomes of adult medulloblastoma patients treated with radiotherapy
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. © 2017, Springer Science+Business Media, LLC.
Keywords: survival; adult; cancer chemotherapy; clinical article; controlled study; aged; middle aged; cancer surgery; young adult; overall survival; constipation; fatigue; bevacizumab; cisplatin; cancer adjuvant therapy; cancer patient; cancer radiotherapy; radiation dose; chemotherapy; temozolomide; follow up; carboplatin; quality of life; multiple cycle treatment; anemia; radiation; etoposide; leukopenia; neuropathy; thrombocytopenia; cohort analysis; cyclophosphamide; vincristine; retrospective study; lomustine; high risk patient; dysphagia; depression; celecoxib; medulloblastoma; nausea and vomiting; sepsis; seizure; weakness; dermatitis; anxiety; isotretinoin; tumor growth; alopecia; ataxia; ototoxicity; posterior fossa; craniospinal irradiation; failure free survival; lobar pneumonia; human; male; female; article; cerebellum tentorium
Journal Title: Journal of Neuro-Oncology
Volume: 136
Issue: 1
ISSN: 0167-594X
Publisher: Springer  
Date Published: 2018-01-01
Start Page: 95
End Page: 104
Language: English
DOI: 10.1007/s11060-017-2627-1
PROVIDER: scopus
PUBMED: 29019042
Notes: Article -- Export Date: 2 April 2018 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Ira J Dunkel
    250 Dunkel
  2. Yasmin Khakoo
    99 Khakoo
  3. Suzanne L Wolden
    417 Wolden
  4. Kathryn Beal
    153 Beal
  5. Suchit Hitesh Patel
    10 Patel
  6. Brian Sandeep De
    9 De