MEDULLOBLASTOMA IN ADULTS

Purpose: To examine the relationship between extent of disease and out come in adults with medulloblastoma. Methods and Materials: We reviewe d the records of all patients over 15 years old with newly diagnosed o r recurrent medulloblastoma treated by or referred to the University o f California, San Francisco, and recorded demographic characteristics, clinical symptoms, radiographic findings, extent of resection, stagin g, myelography, computerized tomography (CT) scans or magnetic resonan ce (MR) images of the spine, histopathological assessment, treatment r eceived, treatment response, recurrence patterns, and survival duratio n. Results: A total of 47 patients were identified, 26 of whom were de signated ''poor-risk'' because they had < 75% removal of tumor, metast atic disease, or brain-stem or leptomeningeal invasion, All patients h ad radiation therapy; 32 had adjuvant chemotherapy, Twenty-two patient s (47%) died of tumor progression, 19 are progression-free, and 6 are alive with disease, The median survival time was 282 weeks in poor-ris k patients and has not been reached in good-risk patients, Overall and disease-free 5-year survival rates differed significantly between the two groups (81% vs, 54%,p = 0.03 and 58% vs, 38%,p = 0.05, respective ly), Tumors most often recurred in the posterior fossa, The median sur vival time from recurrence was 77 weeks (range 44 to 89 weeks). Conclu sion: These findings are similar to those reported for children, There fore, staging and treatment in adults should be approached the same wa y as in children: staging should include cerebrospinal fluid assessmen t and spinal imaging, Treatment should be based on staging, and should include craniospinal irradiation; additional chemotherapy should prob ably be reserved for poor-risk patients.