Treatment for medulloblastoma. Experience of 21 cases

The authors reviewed 21 cases of cerebellar medulloblastoma patients treated at Tohoku University school of Medicine to evaluate efficacy of current treatment. The standard initial treatment protocol was that started with radical surgery followed by cisplatin and etoposide based chemotherapy and craniospinal radiation. Patients less than three years of age were treated by surgery and the chemotherapy followed by craniospinal radiation performed after the age of three. The overall result was that 5-year and 10-year survival rate were 72.9% and 46.8% respectively. Cranial and spinal MRI showed complete remission in 17 of 21 patients after the initial treatment. Factors that correlate with outcome included completeness of surgical resection, the presence or absence of resting tumor after the initial treatment and allocation to one of two risk categories: patients who have undergone complete or subtotal resection and no evidence of cerebrospinal fluid (CSF) dissemination are considered to have low risk, while remaining patients who have larger volumes of residual tumor and those with evidence of CSF dissemination at diagnosis are categorized as high risk. On the other hand, 7 of the 17 patients who showed complete remission after the initial therapy showed recurrence of tumor. They were treated by chemotherapy with local tumor control by radiation and/or surgery. The 5-year survival rate after the recurrence was 36.0%. Complications of the treatment, such as neurocognitive dysfunction, hormonal deficit and auditory dysfunction were seen in 7 of 13 patients who survived more than 2 years. The present study indicates efficacy of the initial therapy that was combined with surgery and radio-chemotherapy for inducing remission of medulloblastomas. Further improvement of determining adequate treatment for recurrent tumor could be problems to be solved. (author)