Treatment of adult nonmetastatic medulloblastoma patients according to the paediatric HIT 2000 protocol: A prospective observational multicentre study |
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Authors: | Carsten Friedrich André O von Bueren Katja von Hoff Robert Kwiecien Torsten Pietsch Monika Warmuth-Metz Peter Hau Frank Deinlein Joachim Kuehl Rolf D Kortmann Stefan Rutkowski |
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Affiliation: | 1. Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany;2. Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany;3. Department of Neuropathology, University of Bonn, Bonn, Germany;4. Department of Neuroradiology, University of Wuerzburg, Wuerzburg, Germany;5. Department of Neurology, University Medical Center Regensburg, Regensburg, Germany;6. Department of Pediatrics, University of Wuerzburg, Wuerzburg, Germany;7. Department of Radiation Oncology, University of Leipzig, Leipzig, Germany |
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Abstract: | BackgroundMedulloblastoma in adulthood is rare. Knowledge is limited, and the efficacy and toxicity of chemotherapy – especially in nonmetastatic disease – is still elusive.MethodsSeventy adults aged ?21 years (median age: 28.5 years) with nonmetastatic medulloblastoma were followed as observational patients within the prospective paediatric multicentre trial HIT 2000. Treatment consisted of radiotherapy (35.2 Gy to the craniospinal axis and a boost to 55.2 Gy to the posterior fossa) followed in most patients by maintenance chemotherapy (lomustine (CCNU), vincristine and cisplatin, n = 49).ResultsThe implementation of maintenance chemotherapy was feasible. Peripheral neuropathy (74%) and haematotoxicity (55%) during maintenance chemotherapy appear to be more common in adults than in children. At a median follow-up of 3.7 years, the 4-year event-free survival (EFS) and overall survival (OS) rates ± standard error (SE) were 68% ± 7% and 89% ± 5%. Patients with desmoplastic medulloblastoma and lateral tumour location (n = 19) had a lower EFS compared to patients with centrally located desmoplastic tumours (n = 10) (p = 0.011). Absence of residual postoperative tumour (n = 40) was associated to a lower rate of progression/relapse compared to present (n = 11) or unknown (n = 12) residual tumour status (p = 0.006). Lateral tumour location and unknown residual tumour status were independent negative prognostic factors.ConclusionsMaintenance chemotherapy is applicable in adults with nonmetastatic medulloblastoma. Histological subtype and tumour location were newly identified risk factors in this age-group, and should be further analysed in prospective trials. |
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