Investigators:  WF Annie Chan, M.D., Jay Loeffler, M.D., Peter Black, M.D., Howard Fine, M.D., David Louis, M.D., Matthew Frosch, M.D., Marek Ancukiewicz Ph.D., Paul Chapman, M.D.

Purpose:  To evaluate the outcome of treatment and identify the prognostic factors of adult medulloblastoma treated in the MRI era.

  Materials & Methods:  Between 1986 and 1996, 32 patients of age 16 or older (median age 25.5 years) without any extra-craniospinal metastasis received their initial treatments at MGH and BWH.  There were 26 males and 6 females.  The Chang stage distribution was as follows: Tl-2, T2-14, T3-8, T4-8, MO-25, MI-1, M2-3, M3-3.  Lesions were midline in 12, hemispheric in 17, and bilateral in 3. Twenty had classical histology and 12 had desmoplastic variant.  Seventeen patients underwent total resection (16 documented by MRI, 1 by CT),  11 subtotal resection, and 4 biopsy only.  All received postoperative conventional radiotherapy with a median dose of 36 Gy to the entire craniospinal axis and 55 Gy to the posterior fossa in 50.5 days (range 36-1 11 days).  Twenty-three patients received multi-agent chemotherapy which mainly consisted of cisplatin and vincristine for 3 cycles.

Results:  With a median follow-up of 5.3 years, 16 patients had recurrences: 4 posterior fossa alone, 4 systemic alone, 2 posterior fossa/spine, 2 posterior fossa/supratentorial/spine, 2 supratentorial/spine, l spine, and I spine/systemic as the first site(s) of recurrence.  The 5-year overall and disease-free survival was 82% and 62% respectively.  The 5-year posterior fossa control (PFC) was 7 1 %. Median time to recurrence was 4.5 years (range 0.2-9.4 years).  In univariate analysis, factors influencing disease-free survival and posterior fossa control were extent of surgery, M stage, brainstem invasion, and duration of radiotherapy, whereas sex, age, histology, location of lesions, and chemotherapy were statistically non-significant.  In multivariate analysis, there was a trend of improved disease-free survival (p=0.05) and posterior fossa control (p=0.08) with complete resection.

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