Survival and pattern of failure after postoperative radiation therapy formedulloblastoma in adult patients

The disease stage was disregarded because of insufficient initial staging. Results . Actuarial 5- and 10- year OS rates were 55% and 44%, respectively. Actuarial 5- and 10- year DFS rates were 44% and 31% respectively. In univariate analysis age was the only significant prognostic factor for OS. For patients less than 30 years of age 5-year OS rate was 40%, for elders – 90%, p=0.004. A tendency to improve OS was observed with better performance and neurologic status, and location in the cerebellar hemisphere, whilst the presence of shunt and gross total resection worsened OS without statistical significance. Tumour recurred in 17 (63%) patients. Ten relapses (59%) occurred within the first 2 years of follow up. Seven recurrences were in the posterior fossa, either alone (3 patients) or both in the posterior fossa and other sites (4 patients). Other relapses occurred either alone or in 2 or more sites such as: the supratentorial region (3 patients), the spine (4 patients), outside the CNS (6 patients). The median SAR was 12 months (1-35 months). Mean SAR for patients receiving chemotherapy at relapse was 19 months, whilst for patients treated without chemotherapy the mean SAR was 5 months. A tendency for longer SAR was observed when recurrence occurred later after primary treatment. Mean SAR for patients relapsed after 3 years was 16 months, whilst for patients relapsed within 3 first years it was 9.5 months. Conclusions . Results are poor, but similar to those cited in literature. Results should be related to the presence of prognostic factors, especially the initial extent of disease. The frequency of recurrences in the posterior fossa and outside the CNS is similar. Accurate initial staging could differentiate patients for whom the use of chemotherapy or implementation of new radiotherapy techniques is meaningful. The majority of relapses were observed within the first 2 years. Older patients have better overall survival.