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Web End = J Neurooncol (2016) 128:235240 DOI 10.1007/s11060-016-2097-x
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Web End = CLINICAL STUDY
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Web End = Adjuvant chemotherapy in adult medulloblastoma: is it an option for average-risk patients?
E. Franceschi1 M. Bartolotti1 A. Paccapelo1 G. Marucci2 R. Agati3
L. Volpin4 D. Danieli5 C. Ghimenton6 M. P. Gardiman7 C. Sturiale8
R. Poggi1 M. Mascarin9 D. Balestrini10 B. Masotto11 A. A. Brandes1
Received: 23 September 2015 / Accepted: 28 February 2016 / Published online: 3 March 2016 Springer Science+Business Media New York 2016
Abstract The standard treatment in children with average-risk medulloblastoma (MB) is reduced-dose radio-therapy (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, dened as no postsurgical residual (or B1.5 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 B1.5 cm) and delay in RT. After a median follow up time of 10 years (range: 813), median survival was 18 years (95 % CI 928) 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 % CI60.097.2 %) and 60.2 % (95 % CI 36.983.5 %), in patients treated with RT alone, and 100, 100 and 100 %, in patients treated with RT plus chemotherapy (p = 0.079). Our ndings suggest a role for adjuvant chemotherapy in the treatment of average-risk MB adult patients. Further improvements might drive to add chemotherapy in
& A. A. Brandes [email protected]
E. Franceschi [email protected]
G. Marucci [email protected]
R. Agati [email protected]
L. Volpin [email protected]
D. Danieli [email protected]
C....