| Abstract: |
Background Adult onset medulloblastoma (aMB) is a rare tumor with limited available evidence. We present a large multi-institutional retrospective cohort of aMB patients treated in the modern era, with an emphasis on understanding the role of chemotherapy at initial diagnosis.Methods We included 267 consecutive patients with aMB treated at 7 different institutions from 2000-present, controlling for chemotherapy regimen and cycles received.Results Treatment factors were highly intercorrelated with one another and with treating institution. Concurrent chemotherapy was not associated with overall survival (OS). Adjuvant chemotherapy was associated with OS on univariable analyses (HR = 0.55, P = .029) and on multivariable analysis when adjusting for risk status (HR 0.55, P = .026) but not when also adjusting for treating institution. Proton craniospinal irradiation was associated with improved survival on univariable (HR = 0.50, P = .019) and multivariable analysis adjusting for risk status (HR = 0.51, P = .024) but not when treating institution was also considered. On subgroup analysis, adjuvant chemotherapy was associated with improved survival in M0 (HR = 0.55, P = .043) but not M1 disease, in patients with subtotal resection (HR = 0.43, P = .048) but not those with GTR. Similarly, progression-free survival was improved with chemotherapy in patients with M0 (HR = 0.57, P = .032) but not M1 disease, and in patients with subtotal (HR = 0.50, P = .054) but not gross total resection.Conclusions There was no benefit of concurrent chemotherapy. Adjuvant chemotherapy was associated with improved overall survival and this effect was driven by select subgroups, specifically those with M0 disease and those with residual tumor. We could not confirm that these associations are independent of the treating institution. Medulloblastoma is a type of brain cancer that mainly affects children, but it can rarely occur in adults. There are well-established treatments for children with medulloblastoma, but it is unclear how adults with the disease should be treated. The authors of this study wanted to see how different chemotherapy treatments were being used in adults with medulloblastoma. To do this, they reviewed the medical records of 267 adults with medulloblastoma from 7 hospitals who were treated with chemotherapy since 2000. Their results showed giving chemotherapy at the same time as radiation did not help patients live longer. However, giving chemotherapy after radiation did make patients live longer, especially when patients had disease that did not spread with tumors remaining after radiation. |
