Metastatic medulloblastoma in adults: outcome of patients treated according to the HIT2000 protocol
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Metastatic medulloblastoma in adults: outcome of patients treated according to the HIT2000 protocol. / von Bueren, André O; Friedrich, Carsten; von Hoff, Katja; Kwiecien, Robert; Müller, Klaus; Pietsch, Torsten; Warmuth-Metz, Monika; Hau, Peter; Benesch, Martin; Kuehl, Joachim; Kortmann, Rolf D; Rutkowski, Stefan.
In: EUR J CANCER, Vol. 51, No. 16, 11.2015, p. 2434-43.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Metastatic medulloblastoma in adults: outcome of patients treated according to the HIT2000 protocol
AU - von Bueren, André O
AU - Friedrich, Carsten
AU - von Hoff, Katja
AU - Kwiecien, Robert
AU - Müller, Klaus
AU - Pietsch, Torsten
AU - Warmuth-Metz, Monika
AU - Hau, Peter
AU - Benesch, Martin
AU - Kuehl, Joachim
AU - Kortmann, Rolf D
AU - Rutkowski, Stefan
N1 - Copyright © 2015 Elsevier Ltd. All rights reserved.
PY - 2015/11
Y1 - 2015/11
N2 - BACKGROUND: Due to the rarity of metastatic medulloblastoma in adults, knowledge about the efficacy and toxicity of intensified chemotherapy and radiotherapy is limited.PATIENTS AND METHODS: Adults with disseminated medulloblastoma registered in the HIT2000 trial as observational patients and treated according to one of two different treatment regimens were analysed. The sandwich strategy MET-HIT2000AB4 consists of postoperative chemotherapy, hyperfractionated craniospinal radiotherapy, and maintenance chemotherapy; while the HIT'91 maintenance strategy consists of postoperative craniospinal radiotherapy, and maintenance chemotherapy.RESULTS: Twenty-three patients (median age: 30.7years), diagnosed from November 2001 to July 2009, and treated in 18 institutions in Germany and Austria, were eligible. The median follow-up of surviving patients was 3.99years. The 4-year event-free survival (EFS) and overall survival (OS)±standard error (SE) were 52%±12% and 91%±6%, respectively. The survival was similar in both treatment groups (HIT'91 maintenance strategy, n=9; MET-HIT2000AB4 sandwich strategy, n=14). Patients with large cell/anaplastic medulloblastoma relapsed and died (n=2; 4-year EFS/OS: 0%) and OS differed compared to patients with classic (n=11; 4-year EFS/OS: 71%/91%) and desmoplastic medulloblastoma (n=10; 4-year EFS/OS: 48%/100%), respectively (p=0.161 for EFS and p=0.033 for OS). Treatment-induced toxicities consisted mainly of neurotoxicity (50% of patients, ⩾ °II), followed by haematotoxicity and nephrotoxicity/ototoxicity. The professional outcome appeared to be negatively affected in the majority of evaluable patients (9/10).CONCLUSIONS: Treatment of adults with metastatic medulloblastoma according to the intensified paediatric HIT2000 protocol was feasible with acceptable toxicities. EFS rates achieved by both chemotherapeutic protocols were favourable and appear to be inferior to those obtained in older children/adolescents with metastatic disease.
AB - BACKGROUND: Due to the rarity of metastatic medulloblastoma in adults, knowledge about the efficacy and toxicity of intensified chemotherapy and radiotherapy is limited.PATIENTS AND METHODS: Adults with disseminated medulloblastoma registered in the HIT2000 trial as observational patients and treated according to one of two different treatment regimens were analysed. The sandwich strategy MET-HIT2000AB4 consists of postoperative chemotherapy, hyperfractionated craniospinal radiotherapy, and maintenance chemotherapy; while the HIT'91 maintenance strategy consists of postoperative craniospinal radiotherapy, and maintenance chemotherapy.RESULTS: Twenty-three patients (median age: 30.7years), diagnosed from November 2001 to July 2009, and treated in 18 institutions in Germany and Austria, were eligible. The median follow-up of surviving patients was 3.99years. The 4-year event-free survival (EFS) and overall survival (OS)±standard error (SE) were 52%±12% and 91%±6%, respectively. The survival was similar in both treatment groups (HIT'91 maintenance strategy, n=9; MET-HIT2000AB4 sandwich strategy, n=14). Patients with large cell/anaplastic medulloblastoma relapsed and died (n=2; 4-year EFS/OS: 0%) and OS differed compared to patients with classic (n=11; 4-year EFS/OS: 71%/91%) and desmoplastic medulloblastoma (n=10; 4-year EFS/OS: 48%/100%), respectively (p=0.161 for EFS and p=0.033 for OS). Treatment-induced toxicities consisted mainly of neurotoxicity (50% of patients, ⩾ °II), followed by haematotoxicity and nephrotoxicity/ototoxicity. The professional outcome appeared to be negatively affected in the majority of evaluable patients (9/10).CONCLUSIONS: Treatment of adults with metastatic medulloblastoma according to the intensified paediatric HIT2000 protocol was feasible with acceptable toxicities. EFS rates achieved by both chemotherapeutic protocols were favourable and appear to be inferior to those obtained in older children/adolescents with metastatic disease.
KW - Adult
KW - Age Factors
KW - Austria
KW - Cerebellar Neoplasms
KW - Chemoradiotherapy, Adjuvant
KW - Cranial Irradiation
KW - Disease Progression
KW - Disease-Free Survival
KW - Dose Fractionation
KW - Female
KW - Germany
KW - Humans
KW - Kaplan-Meier Estimate
KW - Maintenance Chemotherapy
KW - Male
KW - Medulloblastoma
KW - Neurosurgical Procedures
KW - Prospective Studies
KW - Risk Factors
KW - Time Factors
KW - Treatment Outcome
U2 - 10.1016/j.ejca.2015.06.124
DO - 10.1016/j.ejca.2015.06.124
M3 - SCORING: Journal article
C2 - 26254812
VL - 51
SP - 2434
EP - 2443
JO - EUR J CANCER
JF - EUR J CANCER
SN - 0959-8049
IS - 16
ER -
