ETOPOSIDE-CARBOPLATIN ASSOCIATION AS EMERGENCY UP-FRONT CHEMOTHERAPY IN A CASE OF LIFE-THREATENING ADULT MEDULLOBLASTOMA

Medulloblastoma is a rare tumor in the adult population. Current thera pies include surgery and irradiation. Unlike in children, chemotherapy is not commonly used, and its potential has poorly been investigated to date. We report the case of an adult patient with disseminated medu lloblastoma and fulminant neurological deterioration, precluding crani ospinal irradiation. Emergency chemotherapy consisting of carboplatin (400 mg/m(2)) and etoposide (500 mg/m(2)) with intrathecal (i.t.) admi nistration of cytosar and hydrocortisone was initiated. Impressive cli nical response was achieved after the first cycle of chemotherapy, wit h the complete disappearance of the lesions detected by MRI. After 3 c ourses of chemotherapy, the patient underwent craniospinal irradiation (36 Gy to the entire neuraxis and 54 Gy to the posterior fossa). Two years after surgery, the patient was well, with complete clinical reco very, and a new MRI confirmed the disappearance of the lesions. Given the dramatic efficacy of the etoposide-carboplatin association (combin ed with i.t. cytosar), this regimen has to be considered in an emergen cy setting and seems to be a very attractive candidate to be investiga ted as first line therapy for poor risk medulloblastoma in adults.