Metastatic medulloblastoma in adults: Outcome of patients treated according to the HIT2000 protocol

详细信息    查看全文

• 作者：André ; O. von Bueren^a ; ^b ; ¹ ; ^{andre.vonbueren@med.uni-goettingen.de" class="auth_mail" title="E-mail the corresponding author} ; Carsten Friedrich^a ; ^c ; ¹ ; Katja von Hoff^a ; Robert Kwiecien^d ; Klaus Mü ; ller^e ; Torsten Pietsch^f ; Monika Warmuth-Metz^g ; Peter Hau^h ; Martin Beneschⁱ ; Joachim Kuehl^j ; ^&dagger ; ; Rolf D. Kortmann^e ; ² ; Stefan Rutkowski^a ; ²
• 关键词：Brain tumour ; Medulloblastoma ; Adults ; Toxicity ; Treatment ; Radiotherapy ; Chemotherapy ; Prognosis
• 刊名：European Journal of Cancer
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：51
• 期：16
• 页码：2434-2443
• 全文大小：810 K

文摘

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: 30.7 years), 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 3.99 years. 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, 猢?°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.