Treatment of adult nonmetastatic medulloblastoma patients according to the paediatric HIT 2000 protocol: a prospective observational multicentre study
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Treatment of adult nonmetastatic medulloblastoma patients according to the paediatric HIT 2000 protocol: a prospective observational multicentre study. / Friedrich, Carsten; von Bueren, André O; von Hoff, Katja; Kwiecien, Robert; Pietsch, Torsten; Warmuth-Metz, Monika; Hau, Peter; Deinlein, Frank; Kuehl, Joachim; Kortmann, Rolf D; Rutkowski, Stefan.
in: EUR J CANCER, Jahrgang 49, Nr. 4, 4, 2013, S. 893-903.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Treatment of adult nonmetastatic medulloblastoma patients according to the paediatric HIT 2000 protocol: a prospective observational multicentre study
AU - Friedrich, Carsten
AU - von Bueren, André O
AU - von Hoff, Katja
AU - Kwiecien, Robert
AU - Pietsch, Torsten
AU - Warmuth-Metz, Monika
AU - Hau, Peter
AU - Deinlein, Frank
AU - Kuehl, Joachim
AU - Kortmann, Rolf D
AU - Rutkowski, Stefan
N1 - Copyright © 2012 Elsevier Ltd. All rights reserved.
PY - 2013
Y1 - 2013
N2 - BACKGROUND: Medulloblastoma in adulthood is rare. Knowledge is limited, and the efficacy and toxicity of chemotherapy--especially in nonmetastatic disease--is still elusive.METHODS: Seventy adults aged ≥21 years (median age: 28.5 years) with nonmetastatic medulloblastoma were followed as observational patients within the prospective paediatric multicentre trial HIT 2000. Treatment consisted of radiotherapy (35.2 Gy to the craniospinal axis and a boost to 55.2 Gy to the posterior fossa) followed in most patients by maintenance chemotherapy (lomustine (CCNU), vincristine and cisplatin, n=49).RESULTS: The implementation of maintenance chemotherapy was feasible. Peripheral neuropathy (74%) and haematotoxicity (55%) during maintenance chemotherapy appear to be more common in adults than in children. At a median follow-up of 3.7 years, the 4-year event-free survival (EFS) and overall survival (OS) rates±standard error (SE) were 68%±7% and 89%±5%. Patients with desmoplastic medulloblastoma and lateral tumour location (n=19) had a lower EFS compared to patients with centrally located desmoplastic tumours (n=10) (p=0.011). Absence of residual postoperative tumour (n=40) was associated to a lower rate of progression/relapse compared to present (n=11) or unknown (n=12) residual tumour status (p=0.006). Lateral tumour location and unknown residual tumour status were independent negative prognostic factors.CONCLUSIONS: Maintenance chemotherapy is applicable in adults with nonmetastatic medulloblastoma. Histological subtype and tumour location were newly identified risk factors in this age-group, and should be further analysed in prospective trials.
AB - BACKGROUND: Medulloblastoma in adulthood is rare. Knowledge is limited, and the efficacy and toxicity of chemotherapy--especially in nonmetastatic disease--is still elusive.METHODS: Seventy adults aged ≥21 years (median age: 28.5 years) with nonmetastatic medulloblastoma were followed as observational patients within the prospective paediatric multicentre trial HIT 2000. Treatment consisted of radiotherapy (35.2 Gy to the craniospinal axis and a boost to 55.2 Gy to the posterior fossa) followed in most patients by maintenance chemotherapy (lomustine (CCNU), vincristine and cisplatin, n=49).RESULTS: The implementation of maintenance chemotherapy was feasible. Peripheral neuropathy (74%) and haematotoxicity (55%) during maintenance chemotherapy appear to be more common in adults than in children. At a median follow-up of 3.7 years, the 4-year event-free survival (EFS) and overall survival (OS) rates±standard error (SE) were 68%±7% and 89%±5%. Patients with desmoplastic medulloblastoma and lateral tumour location (n=19) had a lower EFS compared to patients with centrally located desmoplastic tumours (n=10) (p=0.011). Absence of residual postoperative tumour (n=40) was associated to a lower rate of progression/relapse compared to present (n=11) or unknown (n=12) residual tumour status (p=0.006). Lateral tumour location and unknown residual tumour status were independent negative prognostic factors.CONCLUSIONS: Maintenance chemotherapy is applicable in adults with nonmetastatic medulloblastoma. Histological subtype and tumour location were newly identified risk factors in this age-group, and should be further analysed in prospective trials.
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Prospective Studies
KW - Prognosis
KW - Survival Rate
KW - Follow-Up Studies
KW - Combined Modality Therapy
KW - Neoplasm Staging
KW - Chemotherapy, Adjuvant
KW - Radiotherapy, Adjuvant
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Vincristine/administration & dosage
KW - Cisplatin/administration & dosage
KW - Cranial Irradiation
KW - Cerebellar Neoplasms/mortality/pathology/therapy
KW - Lomustine/administration & dosage
KW - Medulloblastoma/mortality/pathology/therapy
KW - Neoplasm Recurrence, Local/mortality/pathology/therapy
KW - Adult
KW - Humans
KW - Male
KW - Aged
KW - Female
KW - Middle Aged
KW - Prospective Studies
KW - Prognosis
KW - Survival Rate
KW - Follow-Up Studies
KW - Combined Modality Therapy
KW - Neoplasm Staging
KW - Chemotherapy, Adjuvant
KW - Radiotherapy, Adjuvant
KW - Antineoplastic Combined Chemotherapy Protocols/therapeutic use
KW - Vincristine/administration & dosage
KW - Cisplatin/administration & dosage
KW - Cranial Irradiation
KW - Cerebellar Neoplasms/mortality/pathology/therapy
KW - Lomustine/administration & dosage
KW - Medulloblastoma/mortality/pathology/therapy
KW - Neoplasm Recurrence, Local/mortality/pathology/therapy
U2 - 10.1016/j.ejca.2012.10.006
DO - 10.1016/j.ejca.2012.10.006
M3 - SCORING: Journal article
C2 - 23182688
VL - 49
SP - 893
EP - 903
JO - EUR J CANCER
JF - EUR J CANCER
SN - 0959-8049
IS - 4
M1 - 4
ER -
