PROGNOSIS OF MEDULLOBLASTOMA IN INFANTS

The prognosis of medulloblastoma in children less than 3 years old is usually considered to be rather poor. However, recent experiences with this type of tumour seem to indicate that survival in this specific s ubgroup of patients fan be longer than expected. Nineteen infants with posterior fossa tumours treated by the authors in the period 1983-199 4, all of them with symptoms presenting during the 1st year of life an d all operated on before the end of the 2nd year of life, have been re trospectively analysed. Total tumour removal was achieved in 14 cases, subtotal in I and partial in 3. One subject underwent only a biopsy o f the tumour. In 14 patients a CSF shunt was inserted. Chemotherapy wa s administered to 18 out of the 19 patients in the series. At the time of the study, 11 children had died (57.9%) and 8 were alive (42.1%; m ean survival 86.5 months). One patient died of complications secondary to the surgical treatment. Three patients died because of local recur rence of the tumour after apparent total excision, death supervening 5 , 12 and 18 months after the surgical treatment. A further 2 patients in whom total tumour removal had been performed died 3 and 17 months a fter surgery of local recurrence of the disease associated with region al metastases. Progression of the residual tumour, accompanied by mela static dissemination in 3 cases; accounted for death in the other 5 pa tients who did not survive. Brain stein infiltration appeared to be th e most significant adverse prognostic factor. All 8 long-term survivor s had their tumour totally excised, ][;ive of them underwent radiother apy when at least 2 years old. On the basis of the results, the author s conclude that the current prognosis of infants with medulloblastoma is not necessarily any worse than that of older children with the same disease and that chemotherapy can be particularly useful in this subg roup of patients, as shown by 3 long-term survivals obtained in childr en treated with this type of therapy only.