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Adjuvant chemotherapy in adult medulloblastoma: is it an option for average-risk patients?

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Abstract

The standard treatment in children with average-risk medulloblastoma (MB) is reduced-dose radiotherapy (RT) followed by chemotherapy. However, in adults, there is no agreement on the use of adjuvant chemotherapy. We performed a retrospective analysis of adult MB patients with average-risk disease, defined as no postsurgical residual (or ≤1.5 cm2) and no metastatic disease (M0). Main inclusion criteria were: age >16 years, post-surgical treatment with craniospinal irradiation with or without adjuvant chemotherapy (cisplatin and etoposide ± cyclophosphamide). From 1988 to 2012 were accrued 43 average-risk MB patients treated with surgery and adjuvant RT. Fifteen (34.9 %) patients received also chemotherapy: 7 before RT, 5 after RT, and 3 before and after RT. Reasons to administer chemotherapy were presence of residual disease (even if ≤1.5 cm) and delay in RT. After a median follow up time of 10 years (range: 8–13), median survival was 18 years (95 % CI 9–28) in patients who receive RT alone, and was not reached in patients treated with RT plus chemotherapy. The survival rates at 5, 10 and 15 years were 100 %, 78.6 % (95 % CI 60.0–97.2 %) and 60.2 % (95 % CI 36.9–83.5 %), in patients treated with RT alone, and 100, 100 and 100 %, in patients treated with RT plus chemotherapy (p = 0.079). Our findings suggest a role for adjuvant chemotherapy in the treatment of average-risk MB adult patients. Further improvements might drive to add chemotherapy in average-risk setting with less favourable biological signatures (i.e., non-WNT group).

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Authors’ contribution

EF. conceived the study and participated in its design, coordination and draft. M.B. participated in the coordination and draft of the study. A.P. carried out the statistical analysis. G.M. carried out histopathological diagnosis. R.A. did the neuroradiological evaluations. L.V. performed surgery and provided patients. D.D. carried out histopathological diagnosis. C.G carried out histopathological diagnosis. M.P.G. carried out histopathological diagnosis. C.S. performed surgery and provided patients. R.P. participated in data collection. M.M. provided data about radiotherapy treatment. D.B. provided data about radiotherapy treatment. B.M. performed surgery and provided patients. A.A.B conceived the study and participated in its design, coordination and draft.

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Authors and Affiliations

  1. Department of Medical Oncology, Bellaria-Maggiore Hospitals, Azienda USL – IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy

    E. Franceschi, M. Bartolotti, A. Paccapelo, R. Poggi & A. A. Brandes

  2. Section of Pathology “M. Malpighi”, Bellaria-Maggiore Hospitals, Azienda USL – IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy

    G. Marucci

  3. Department of Neuroradiology, Bellaria-Maggiore Hospitals, Azienda USL – IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy

    R. Agati

  4. Department of Neuroscience and Neurosurgery, San Bortolo Hospital, Viale Rodolfi, 37, 36100, Vicenza, Italy

    L. Volpin

  5. Pathology Department, San Bortolo Hospital, Viale Rodolfi, 37, 36100, Vicenza, Italy

    D. Danieli

  6. Pathology Department, Verona Hospital, P.le A. Stefani 1, 37126, Verona, Italy

    C. Ghimenton

  7. Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University Hospital, Via Giustiniani, 1, 35121, Padua, Italy

    M. P. Gardiman

  8. Department of Neurosurgery, Bellaria Hospital, Azienda USL - IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy

    C. Sturiale

  9. Department of Radiotherapy Unit, CRO, Via Franco Gallini, 233081, Aviano, Italy

    M. Mascarin

  10. Department of Radiotherapy, Bellaria-Maggiore Hospitals, Azienda USL – IRCCS Institute of Neurological Sciences, Via Altura, 3, 40139, Bologna, Italy

    D. Balestrini

  11. Department of Neurosurgery, Verona Hospital, P.le A. Stefani 1, 37126, Verona, Italy

    B. Masotto

Authors
  1. E. Franceschi
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  2. M. Bartolotti
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  3. A. Paccapelo
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  4. G. Marucci
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  5. R. Agati
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  6. L. Volpin
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  7. D. Danieli
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  8. C. Ghimenton
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  9. M. P. Gardiman
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  10. C. Sturiale
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  11. R. Poggi
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  12. M. Mascarin
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  13. D. Balestrini
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  14. B. Masotto
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  15. A. A. Brandes
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Corresponding author

Correspondence to A. A. Brandes.

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Franceschi, E., Bartolotti, M., Paccapelo, A. et al. Adjuvant chemotherapy in adult medulloblastoma: is it an option for average-risk patients?. J Neurooncol 128, 235–240 (2016). https://doi.org/10.1007/s11060-016-2097-x

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  • DOI: https://doi.org/10.1007/s11060-016-2097-x

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