Korean J Pediatr Hematol Oncol.
2004 Oct;11(2):187-194.
High Risk Medulloblastoma in Childhood: Multidisciplinary Approach and Improved Outcome
- Affiliations
-
- 1Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. tghim@amc.seoul.kr
- 2Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 3Department of Therapeutic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 4Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 5Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
- 6Department of Pediatrics, Dankook University College of Medicine, Cheonan, Korea.
- 7Ye In Pediatric Clinic, Seoul, Korea.
Abstract
- PURPOSE
Medulloblastoma is the most common malignant brain tumor in childhood. The standard treatments are composed of tumor resection, irradiation and chemotherapy. In this study, we analysed the outcome of high risk medulloblastoma patients who were treated with surgical resection followed by craniospinal irradiation and chemotherapy utilizing cisplatin, vincristine, cyclophosphamide and etoposide. METHODS: We conducted a retrospective analysis of medical record of twenty-five patients with high risk medulloblastoma, treated from January 1998 to April 2004 in the Department of Pediatrics, Neurosurgery and Radiation Oncology at Asan Medical Center. RESULTS: The median age at diagnosis was 9 years and 10 month. The 2-year overall survival rate was 80%, and 2-year progression-free survival rate was 71%. Degree of surgical resections or residual tumor did not show statistically significant differences of survival rate, but there was difference depending on metastasis staging. The side effects of chemotherapy were grade IV hematologic toxicity (n=20), SIADH (n=2), and severe paralytic ileus (n=1). The long-term sequelae were endocrinopathy (n=6) that include growth failure, precocious puberty and hypothyroidism. Neurological complications such as mild mental retardation and ataxia occurred in seven patients. There was no treatment-related mortality. Four patients died of tumor progression. CONCLUSION: Patients with high risk medulloblastoma treated with surgical resection followed by radiation and chemotherapy as described here show satisfactory outcome. In this high risk group, metastasis staging correlated with outcome but the degree of surgical resection and presence or absence of residual tumor at primary site did not correlate with outcome.
Keyword
MeSH Terms
-
Ataxia
Brain Neoplasms
Child
Chungcheongnam-do
Cisplatin
Craniospinal Irradiation
Cyclophosphamide
Diagnosis
Disease-Free Survival
Drug Therapy
Etoposide
Humans
Hypothyroidism
Inappropriate ADH Syndrome
Intellectual Disability
Intestinal Pseudo-Obstruction
Medical Records
Medulloblastoma*
Mortality
Neoplasm Metastasis
Neoplasm, Residual
Neurosurgery
Pediatrics
Puberty, Precocious
Radiation Oncology
Retrospective Studies
Survival Rate
Vincristine
Cisplatin
Cyclophosphamide
Etoposide
Vincristine
