MEDULLOBLASTOMA - IS THE 5-YEAR SURVIVAL RATE IMPROVING - A REVIEW OF80 CASES FROM A SINGLE INSTITUTION

A series of 80 cases of medulloblastomas in children undergoing operat ion and postoperatively followed between 1980 and 1990 at Great Ormond Street Hospital for Children (GOSH) has been reviewed and compared to an earlier series reported from the same institution by McIntosh. The overall 5-year survival rate for the present series was 50%, although three patients died after surviving 5 years. The operative mortality rate was 5%. Survival analysis revealed that the presence or absence o f spinal metastases and the necessity for some form of cerebrospinal f luid diversion within 30 days of the operation independently significa ntly affected survival in this series. Those patients with no spinal m etastasis and total tumor removal had a 5-year survival rate of 73%, m aking this the most favorable subgroup in the series. Patient age and gender, duration of symptoms, Chang T stages, tumor volume, extent of resection, and postoperative chemotherapy were not significant variabl es. Although these results are better than those reported in the earli er GOSH series, they are not significantly different from the results of the second 5-year cohort of patients described in that article. Rad iotherapy remains the greatest advance in treatment, although it is ho ped that further improvement will result from the various chemotherapy protocols now being studied and from increasing knowledge of the biol ogical behavior of these tumors.