Common strategy for adult and pediatric medulloblastoma: A multicenter series of 253 adults
Common strategy for adult and pediatric medulloblastoma: A multicenter series of 253 adults
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DOI：
10.1016/j.ijrobp.2006.12.030
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发表时间：
2007-06-01
影响因子：
7
通讯作者：
Carrie, Christian
中科院分区：
文献类型：
--
作者：
Padovani, Laetitia;Sunyach, Marie-Pierre;Carrie, Christian
目的：在一项多中心回顾性研究中评估成人髓母细胞瘤的预后因素。方法与材料：对1975 ~ 2004年间收治的253例成人进行资料查阅和邮件查询。放射科医生或外科医生评估疾病特征，如体积和延伸。患者被分为高风险和标准风险两类。分析预后因素。结果：患者中位年龄为29岁。中位随访时间为7年。其中放疗246例，放化疗142例。74例患者复发。5年和10年的总生存率分别为72%和55%。单因素分析显示，生存率与转移、术后工作状态、脑干受累、第四脑室底受累（V4）、脊柱和脑后窝（PCF）辐射剂量显著相关。通过多因素分析，脑干、V4受累和PCF剂量为不良预后因素。在标准风险亚组中，轴向剂量为34 Gy的患者和颅脊髓剂量< 34 Gy加化疗的患者的总生存期没有差异。结论：我们报道了成人中最大的髓母细胞瘤系列。预后因素与儿童相似。结果表明，标准风险疾病患者可以通过放化疗治疗，减少对颅脊髓区的剂量，保持至少50 Gy的PCF。化疗对这一群体的作用尚不清楚。应该进行随机研究来证实这些结果，但由于频率非常低，这样的研究将是困难的。(C) 2007爱思唯尔公司
Purpose: To assess prognostic factors for adults with medulloblastoma in a multicenter, retrospective study.Methods and Materials: Data were collected by file review or mail inquiry for 253 adults treated between 1975 to 2004. Radiologists or surgeons assessed disease characteristics, such as volume and extension. Patients were classified as having either high- or standard-risk disease. Prognostic factors were analyzed.Results: Median patient age was 29 years. Median follow-up was 7 years. Radiotherapy was delivered in 246 patients and radiochemotherapy in 142. Seventy-four patients relapsed. Respective 5- and 10-year overall survival rates were 72% and 55%. Univariate analysis showed that survival significantly correlated with metastasis, postsurgical performance status, brainstem involvement, involvement of the floor of the fourth ventricle (V4), and radiation dose to the spine and to the posterior cerebral fossa (PCF). By multivariate analysis, brainstem, V4 involvement, and dose to the PCF were negative prognostic factors. In the standard-risk subgroup there was no overall survival difference between patients treated with axial doses of :34 Gy and patients treated with craniospinal doses < 34 Gy plus chemotherapy.Conclusion: We report the largest series of medulloblastoma in adults. Prognostic factors were similar to those observed in children. Results suggest that patients with standard-risk disease could be treated with radiochemotherapy, reducing doses to the craniospinal area, maintaining at least 50 Gy to the PCF. The role of chemotherapy for this group is still unclear. A randomized study should be performed to confirm these results, but because frequency is very low, such a study would be difficult. (C) 2007 Elsevier Inc.