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Patterns of failure in patients with medulloblastoma
Author(s) -
Jereb Berta,
Reid Ann,
Ahuja Rajender K.
Publication year - 1982
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19821215)50:12<2941::aid-cncr2820501239>3.0.co;2-6
Subject(s) - medicine , vincristine , surgery , medulloblastoma , chemotherapy , cyclophosphamide , radiation therapy , prednisone , lomustine , procarbazine , cancer , localized disease , pathology , prostate cancer
Fifty‐two patients with medulloblastoma were seen at Memorial Sloan‐Kettering Cancer Center (MSKCC) between 1959 and 1979. All patients had their primary surgery at other institutions; 27 were referred postoperatively for the initial course of radiation therapy; 24 were referred for treatment of recurrence and 1 patient for adjuvant chemotherapy only. The patients were classified as: (1) Group I: small, localized tumor which was completely excised (14 patients), (2) Group II: large, localized, incompletely excised tumor (10 patients), (3) Group III: tumor spread within the central nervous system (8 patients), (4) Group IV: hematogenous metastases at initial presentation (2 patients). Eighteen patients could not be classified due to insufficient data. Of the 27 patients who received initial radiation treatments at MSKCC, six were of the Groups III and IV and all of these have died. Of the remaining 21 patients with localized disease ten are alive and disease‐free with follow‐up from 20 to 81 months. One patient died free of disease, at 11 months, due to chemotherapy toxicity. Fourteen patients received adjuvant chemotherapy: three received a single drug while 11 received multiple drugs in various combinations of vincristine, cyclophosphamide, methotrexate, lomustin, (CCNU), and prednisone. The extent of disease at the initial treatment was the most important prognostic factor. There were no survivors in the Groups III and IV. The most common site of recurrence was the posterior fossa, 21 of 40 patients, (53%), six patients (15%) had recurrence at the cribriform plate and the adjoining medial frontal lobes, and five (12%) had their first recurrence outside the CNS. None of the patients who received less than 3400 rad to the craniospinal axis or less than 5000 rad to the posterior fossa is alive. The duration of treatment seems to be of less importance for the outcome than the total dose of radiation delivered.