Adjuvant chemotherapy in adult medulloblastoma

is it an option for average-risk patients?

Enrico Franceschi, Marco Bartolotti, A. Paccapelo, Gianluca Marucci, Raffaele Agati, Lorenzo Volpin, Daniela Danieli, Claudio Ghimenton, Marina Gardiman, Carmelo Sturiale, R. Poggi, Maurizio Mascarin, Damiano Balestrini, B. Masotto, A. Brandes

Research output: Contribution to journalArticle

Abstract

The standard treatment in children with average-risk medulloblastoma (MB) is reduced-dose radiotherapy (RT) followed by chemotherapy. However, in adults, there is no agreement on the use of adjuvant chemotherapy. We performed a retrospective analysis of adult MB patients with average-risk disease, defined as no postsurgical residual (or ≤1.5 cm2) and no metastatic disease (M0). Main inclusion criteria were: age >16 years, post-surgical treatment with craniospinal irradiation with or without adjuvant chemotherapy (cisplatin and etoposide ± cyclophosphamide). From 1988 to 2012 were accrued 43 average-risk MB patients treated with surgery and adjuvant RT. Fifteen (34.9 %) patients received also chemotherapy: 7 before RT, 5 after RT, and 3 before and after RT. Reasons to administer chemotherapy were presence of residual disease (even if ≤1.5 cm) and delay in RT. After a median follow up time of 10 years (range: 8–13), median survival was 18 years (95 % CI 9–28) in patients who receive RT alone, and was not reached in patients treated with RT plus chemotherapy. The survival rates at 5, 10 and 15 years were 100 %, 78.6 % (95 % CI 60.0–97.2 %) and 60.2 % (95 % CI 36.9–83.5 %), in patients treated with RT alone, and 100, 100 and 100 %, in patients treated with RT plus chemotherapy (p = 0.079). Our findings suggest a role for adjuvant chemotherapy in the treatment of average-risk MB adult patients. Further improvements might drive to add chemotherapy in average-risk setting with less favourable biological signatures (i.e., non-WNT group).

Original languageEnglish
Pages (from-to)235-240
Number of pages6
JournalJournal of Neuro-Oncology
DOIs
Publication statusPublished - 2016

Fingerprint

Medulloblastoma
Adjuvant Chemotherapy
Radiotherapy
Drug Therapy
Craniospinal Irradiation
Adjuvant Radiotherapy
Etoposide
Cyclophosphamide
Cisplatin
Therapeutics
Survival Rate
Survival

Keywords

  • Adults
  • Average risk
  • Chemotherapy
  • Medulloblastoma
  • Radiotherapy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neurology

Cite this

Adjuvant chemotherapy in adult medulloblastoma : is it an option for average-risk patients? / Franceschi, Enrico; Bartolotti, Marco; Paccapelo, A.; Marucci, Gianluca; Agati, Raffaele; Volpin, Lorenzo; Danieli, Daniela; Ghimenton, Claudio; Gardiman, Marina; Sturiale, Carmelo; Poggi, R.; Mascarin, Maurizio; Balestrini, Damiano; Masotto, B.; Brandes, A.

In: Journal of Neuro-Oncology, 2016, p. 235-240.

Research output: Contribution to journalArticle

Franceschi, E, Bartolotti, M, Paccapelo, A, Marucci, G, Agati, R, Volpin, L, Danieli, D, Ghimenton, C, Gardiman, M, Sturiale, C, Poggi, R, Mascarin, M, Balestrini, D, Masotto, B & Brandes, A 2016, 'Adjuvant chemotherapy in adult medulloblastoma: is it an option for average-risk patients?', Journal of Neuro-Oncology, pp. 235-240. https://doi.org/10.1007/s11060-016-2097-x
Franceschi, Enrico ; Bartolotti, Marco ; Paccapelo, A. ; Marucci, Gianluca ; Agati, Raffaele ; Volpin, Lorenzo ; Danieli, Daniela ; Ghimenton, Claudio ; Gardiman, Marina ; Sturiale, Carmelo ; Poggi, R. ; Mascarin, Maurizio ; Balestrini, Damiano ; Masotto, B. ; Brandes, A. / Adjuvant chemotherapy in adult medulloblastoma : is it an option for average-risk patients?. In: Journal of Neuro-Oncology. 2016 ; pp. 235-240.
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abstract = "The standard treatment in children with average-risk medulloblastoma (MB) is reduced-dose radiotherapy (RT) followed by chemotherapy. However, in adults, there is no agreement on the use of adjuvant chemotherapy. We performed a retrospective analysis of adult MB patients with average-risk disease, defined as no postsurgical residual (or ≤1.5 cm2) and no metastatic disease (M0). Main inclusion criteria were: age >16 years, post-surgical treatment with craniospinal irradiation with or without adjuvant chemotherapy (cisplatin and etoposide ± cyclophosphamide). From 1988 to 2012 were accrued 43 average-risk MB patients treated with surgery and adjuvant RT. Fifteen (34.9 {\%}) patients received also chemotherapy: 7 before RT, 5 after RT, and 3 before and after RT. Reasons to administer chemotherapy were presence of residual disease (even if ≤1.5 cm) and delay in RT. After a median follow up time of 10 years (range: 8–13), median survival was 18 years (95 {\%} CI 9–28) in patients who receive RT alone, and was not reached in patients treated with RT plus chemotherapy. The survival rates at 5, 10 and 15 years were 100 {\%}, 78.6 {\%} (95 {\%} CI 60.0–97.2 {\%}) and 60.2 {\%} (95 {\%} CI 36.9–83.5 {\%}), in patients treated with RT alone, and 100, 100 and 100 {\%}, in patients treated with RT plus chemotherapy (p = 0.079). Our findings suggest a role for adjuvant chemotherapy in the treatment of average-risk MB adult patients. Further improvements might drive to add chemotherapy in average-risk setting with less favourable biological signatures (i.e., non-WNT group).",
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AU - Marucci, Gianluca

AU - Agati, Raffaele

AU - Volpin, Lorenzo

AU - Danieli, Daniela

AU - Ghimenton, Claudio

AU - Gardiman, Marina

AU - Sturiale, Carmelo

AU - Poggi, R.

AU - Mascarin, Maurizio

AU - Balestrini, Damiano

AU - Masotto, B.

AU - Brandes, A.

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