Abstract
BACKGROUND
Medulloblastoma in adults is exceedingly rare, and treatment strategies are largely derived from data in the pediatric medulloblastoma population. The aim of this study was to evaluate treatment patterns and survival in adults with medulloblastoma. We performed a retrospective study of the California Cancer Registry (CCR), to evaluate the effect of treatment variables and social demographics on survival in adults.
METHODS
Treatment and demographic data were extracted from the CCR for adult patients (18 years and older) with medulloblastoma. Patients were diagnosed from January 1, 1988 through December 31, 2010. We restricted the data to patients who had complete records for extent of resection, radiation, chemotherapy and demographic variables. Surgery was dichotomized to Gross Total Resection (GTR) and Subtotal Resection/Biopsy (STR/B). A total of 292 patients were included. Kaplan Meier (KM) survival curves were performed for OS. Bivariate and multivariate analyses were done by cox proportional hazard regression model for all variables.
RESULTS
There were 245 cases of classic adult medulloblastoma, 40 desmoplastic, 6 large cell and 1 medullomyoblastoma. 37% underwent GTR and 63% had STR/B. 82% received radiation and 42% of the patients underwent some form of chemotherapy (single agent or multiagent). Median OS for patients undergoing GTR was not reached, vs 115 months for STR/biopsy (HR 0.585). Median OS for patients with radiation was significantly associated with improved OS (211 months vs 56 months, (HR 0.450). There was no survival advantage for patients who received chemotherapy (155 months with chemotherapy vs 180 months without, (HR 1.081). Multivariate analysis again showed GTR and radiation to be significant predictors of OS, but not chemotherapy. Marital status and age were significant predictors of OS, but not race or gender.
CONCLUSION
Radiation and GTR were significantly associated with longer OS. Chemotherapy was not associated with an improvement in OS.