Shunt related abdominal metastases in an infant with medulloblastoma: Longterm remission by systemic chemotherapy and surgery

This is the first reported case of long remission of abdominal metastases s pread through a ventriculo-peritoneal shunt in an infant diagnosed, four ye ars ago, at age 1 year and 10 months, to have cerebral medulloblastoma. Two years later, while in second complete remission of his cerebral tumor, he showed abdominal metastases, successfully treated by platinum based chemoth erapy and surgery. One year later, a second abdominal relapse and hepatic m etastases were treated by doxorubicin administration and surgery. Since the n the child remained in continuous complete remission. This unusual favorab le outcome can be explained by an extreme responsiveness of the tumor, unpr otected by the blood brain barrier, to systemic chemotherapy, particularly to doxorubicin administration. The need for careful surveillance of patient s with ventriculo-peritoneal shunts is emphasized. Searching for new tools, such as entrapment of doxorubicin in liposomes, able to overcome the blood -brain barrier and to expose brain tumors to effective drugs, probably repr esents the best choice for future treatment strategies of CNSbreak tumors.