TY - JOUR
T1 - Relapse in medulloblastoma
T2 - What can be done after abandoning high-dose chemotherapy? A mono-institutional experience
AU - Massimino, Maura
AU - Casanova, Michela
AU - Polastri, Daniela
AU - Biassoni, Veronica
AU - Modena, Piergiorgio
AU - Pecori, Emilia
AU - Schiavello, Elisabetta
AU - De Pava, Marco Vajna
AU - Indini, Alice
AU - Rampini, Paolo
AU - Bauer, Dario
AU - Catania, Serena
AU - Podda, Marta
AU - Gandola, Lorenza
PY - 2013/7
Y1 - 2013/7
N2 - Purpose: We retrospectively report strategies used for medulloblastoma patients progressing after craniospinal irradiation where we aimed for: symptom control, a satisfactory quality of life, accrual in phase 1-2 trials, when available, and the first two conditions could no longer be satisfied by already experienced second-line strategies. Methods: Surgery was used in cases of doubtful relapse or when only one site was affected. Radiotherapy was given whenever possible, especially to relieve symptoms. The main chemotherapy regimens were oral temozolomide/etoposide, intravenous (iv.) cisplatin/etoposide, iv. gemcitabine/oxaliplatin, an oral sonic hedgehog pathway inhibitor and oral melphalan. Results: Between 1998 and 2011, we treated 18 patients relapsed after median 20 months. Nine had relapsed locally, four had dissemination, three single metastases, and two had one synchronous local and metastatic recurrence. Responses to chemotherapy were seen in 32 % of cases. The median hospital stay for treatments/complications was 19 days. The 1- and 3-year progression-free survival (PFS) rates were 28 ± 10 % and 0 %, respectively, for OS, they were 44 ± 12 % and 22 ± 10 % but no patient was cured. The median PFS after a first relapse was 7 months (range 1-29); the median OS was 7 months (range 4-44). No patients died due to treatment toxicity. Late recurrence (more than 1-2 years after diagnosis) and involvement of single sites were favorable prognostic factors. Conclusions: Without succeeding in patients cure, we ensured them further treatment with short hospital stay thus affording low personal and social costs. The chances of cure may emerge from tailored therapies according to genetic stratification.
AB - Purpose: We retrospectively report strategies used for medulloblastoma patients progressing after craniospinal irradiation where we aimed for: symptom control, a satisfactory quality of life, accrual in phase 1-2 trials, when available, and the first two conditions could no longer be satisfied by already experienced second-line strategies. Methods: Surgery was used in cases of doubtful relapse or when only one site was affected. Radiotherapy was given whenever possible, especially to relieve symptoms. The main chemotherapy regimens were oral temozolomide/etoposide, intravenous (iv.) cisplatin/etoposide, iv. gemcitabine/oxaliplatin, an oral sonic hedgehog pathway inhibitor and oral melphalan. Results: Between 1998 and 2011, we treated 18 patients relapsed after median 20 months. Nine had relapsed locally, four had dissemination, three single metastases, and two had one synchronous local and metastatic recurrence. Responses to chemotherapy were seen in 32 % of cases. The median hospital stay for treatments/complications was 19 days. The 1- and 3-year progression-free survival (PFS) rates were 28 ± 10 % and 0 %, respectively, for OS, they were 44 ± 12 % and 22 ± 10 % but no patient was cured. The median PFS after a first relapse was 7 months (range 1-29); the median OS was 7 months (range 4-44). No patients died due to treatment toxicity. Late recurrence (more than 1-2 years after diagnosis) and involvement of single sites were favorable prognostic factors. Conclusions: Without succeeding in patients cure, we ensured them further treatment with short hospital stay thus affording low personal and social costs. The chances of cure may emerge from tailored therapies according to genetic stratification.
KW - Childhood brain tumors
KW - Dissemination
KW - Hospital stay
KW - Medulloblastoma
KW - Treatment toxicity
UR - http://www.scopus.com/inward/record.url?scp=84879223643&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84879223643&partnerID=8YFLogxK
U2 - 10.1007/s00381-013-2104-x
DO - 10.1007/s00381-013-2104-x
M3 - Article
AN - SCOPUS:84879223643
VL - 29
SP - 1107
EP - 1112
JO - Child's Nervous System
JF - Child's Nervous System
SN - 0256-7040
IS - 7
ER -