- 作者：Maura Massimino ; Lorenza G ; ola ; Filippo Spreafico ; Veronica Biassoni ; Roberto Luksch ; Paola Collini ; Carlo N. Solero ; Fabio Simonetti ; Emanuele Pignoli ; Graziella Cefalo ; Geraldina Poggi ; Piergiorgio
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2009
- 出版时间：1 April 2009
- 年：2009
- 卷：73
- 期：5
- 页码：1358-1363
- 全文大小：152 K
Purpose
Myeloablative regimens were frequently used for medulloblastoma relapsing after craniospinal irradiation (CSI): in 1997–2002, we used repeated surgery, standard-dose and myeloablative chemotherapy, and reirradiation.Methods and Materials
In 10 patients, reinduction included sequential high-dose etoposide, high-dose cyclophosphamide/vincristine, and high-dose carboplatin/vincristine, then two myeloablative courses with high-dose thiotepa (± carboplatin); 6 other patients received two of four courses of cisplatin/etoposide. Hematopoietic precursor mobilization followed high-dose etoposide or high-dose cyclophosphamide or cisplatin/etoposide therapy. After the overall chemotherapy program, reirradiation was prescribed when possible.
Results
Seventeen patients were treated: previous treatment included CSI of 19.5–36 Gy with posterior fossa/tumor boost and chemotherapy in 16 patients. Fifteen patients were in their first and 2 in their second and third relapses, respectively. First progression-free survival had lasted a median of 26 months. Relapse sites included leptomeninges in 9 patients, spine in 4 patients, posterior fossa in 3 patients, and brain in 1 patient. Three patients underwent complete resection of recurrence, and 10 underwent reirradiation. Twelve of 14 patients with assessable tumor had an objective response after reinduction; 2 experienced progression and were not given the myeloablative courses. Remission lasted a median of 16 months. Additional relapses appeared in 13 patients continuing the treatment. Fifteen patients died of progression and 1 died of pneumonia 13 months after relapse. The only survivor at 93 months had a single spinal metastasis that was excised and irradiated. Survival for the series as a whole was 11–93 months, with a median of 41 months.
Conclusions
Despite responses being obtained and ample use of surgery and reirradiation, second-line therapy with myeloablative schedules was not curative, barring a few exceptions. A salvage therapy for medulloblastoma after CSI still needs to be sought.