ADULT MEDULLOBLASTOMA - AN ANALYSIS OF SURVIVAL AND PROGNOSTIC FACTORS

PURPOSE This analysis aimed to review the experience in the management of adult medulloblastoma at the University of California, San Francis co, and to identify important prognostic factors for survival and post erior fossa control. PATIENTS AND METHODS We performed a retrospective review of 34 adult patients, age greater than or equal to 15, with ce rebellar medulloblastoma treated with radiotherapy at the University o f California, San Francisco from 1970 to 1994. All patients underwent a surgical procedure (complete resection in 17, subtotal resection in 10, and biopsy alone in seven), followed by craniospinal irradiation. Most patients treated after 1979 also received chemotherapy. Twenty we re classified as poor-risk due to either incomplete resection or evide nce of disease outside of the posterior fossa at diagnosis. RESULTS Th e 5-year posterior fossa control and overall survival rates were 61% a nd 58%, respectively. The majority of relapses occurred in the posteri or fossa (14 of 17). Multivariate analysis revealed that age (favoring older patients), gender (favoring female patients), and extent of dis ease at diagnosis (favoring localized disease) were important prognost ic factors for posterior fossa control. There was a trend toward impro ved posterior fossa control with higher radiation dose to the posterio r fossa in patients with a complete resection. Gender and extent of di sease at presentation were significant prognostic factors for survival . The 5-year survival rates were 92% for female patients versus 40% fo r male patients, and 67% for patients with localized disease versus 25 % for those with disseminated disease. The prognosis following recurre nce was poor; all died of the disease. DISCUSSION Survival for adult m edulloblastoma was comparable to its pediatric counterpart. In patient s with localized disease at presentation, gender (favoring female pati ents) and age (favoring older patients) were important prognostic fact ors for posterior fossa control and survival. In patients with dissemi nated disease at presentation, the prognosis is poor, and innovative t herapy is needed to improve survival.