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Reduced-dose craniospinal irradiation is feasible for standard-risk adult medulloblastoma patients

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Abstract

Introduction

Medulloblastoma is the most common malignant brain tumor in children, but accounts for only 1% of brain cancers in adults. For standard-risk pediatric medulloblastoma, current therapy includes craniospinal irradiation (CSI) at reduced doses (23.4 Gy) associated with chemotherapy. Whereas most same-stage adult patients are still given CSI at 36 Gy, with or without chemotherapy, we report here on our use of reduced-dose CSI associated with chemotherapy for older patients.

Methods

We gathered non-metastatic patients over 18 years old (median age 28 years, range 18–48) with minimal or no residual disease after surgery, no negative histological subtypes, treated between 1996–2018 at the Centre Léon Bérard (Lyon) and the INT (Milano). A series of 54 children with similar tumors treated in Milano was used for comparison.

Results

Forty-four adults were considered (median follow-up 101 months): 36 had 23.4 Gy of CSI, and 8 had 30.6 Gy, plus a boost to the posterior fossa/tumor bed; 43 had chemotherapy as all 54 children, who had a median 83-month follow-up. The PFS and OS were 82.2 ± 6.1% and 89 ± 5.2% at 5 years, and 78.5 ± 6.9% and 75.2 ± 7.8% at ten, not significantly different from those of the children. CSI doses higher than 23.4 Gy did not influence PFS. Female adult patients tended to have a better outcome than males.

Conclusion

The results obtained in our combined series are comparable with, or even better than those obtained after high CSI doses, underscoring the need to reconsider this treatment in adults.

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Acknowledgements

Associazione Bianca Garavaglia, Busto Arsizio; LILT (Lega Italiana per la Lotta contro i Tumori), Milano; Con Lorenzo per mano Onlus, Como; Bimbo Tu Onlus, Bologna

Funding

Associazione Bianca Garavaglia, Busto Arsizio; LILT (Lega Italiana per la Lotta contro i Tumori), Milano; Con Lorenzo per mano Onlus, Como; Bimbo Tu Onlus, Bologna.

Author information

Authors and Affiliations

  1. Pediatric Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133, Milan, Italy

    Maura Massimino, Filippo Spreafico, Luna Boschetti, Veronica Biassoni, Elisabetta Schiavello, Andrea Ferrari, Monica Terenziani, Michela Casanova, Roberto Luksch, Cristina Meazza, Marta Podda, Stefano Chiaravalli, Nadia Puma & Luca Bergamaschi

  2. Radiotherapy Department, Centre Léon Bérard, Lyon, France

    Marie Pierre Sunyach

  3. Clinical Epidemiology and Trial Organization Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy

    Francesco Barretta

  4. Pediatric Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Via Venezian 1, 20133, Milan, Italy

    Lorenza Gandola, Emilia Pecori & Barbara Diletto

  5. Milan, Italy

    Anna Garegnani

  6. Neuro-Oncology, Centre Léon Bérard, Lyon, France

    Alice Bonneville-Levard & Didier Frappaz

  7. Pathology Department, Centre Hospitalo-Universitaire, Lyon, France

    David Meyronet

  8. Neurosurgery Department, Centre Hospitalo-Universitaire, Lyon, France

    Carmine Mottolese

  9. Neurosurgery Unit, University of Milano-Bicocca, Ospedale San Gerardo, Monza, Italy

    Carlo Giussani

  10. Neurosurgery Unit, Ospedale Policlinico Ca’ Granda, Milano, Italy

    Giorgio Carrabba

  11. Nuclear Medicine Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy

    Federica Pallotti

  12. Neurosurgery Unit, Legnano Hospital, Milan, Italy

    Roberto Stefini

  13. Department of Radiological, Oncological and Anatomo-Pathological Sciences, Sapienza University, Rome, Italy

    Felice Giangaspero & Manila Antonelli

  14. Pathology Department, IRCCS Neuromed, Pozzilli, Italy

    Felice Giangaspero

  15. Neurological Science, Sapienza University, Roma, Italy

    Francesca Romana Buttarelli

  16. Radiology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy

    Carlo Morosi & Giuseppina Calareso

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  1. Maura Massimino
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  2. Marie Pierre Sunyach
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  3. Francesco Barretta
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  31. Manila Antonelli
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  32. Francesca Romana Buttarelli
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  33. Didier Frappaz
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Correspondence to Maura Massimino.

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Massimino, M., Sunyach, M.P., Barretta, F. et al. Reduced-dose craniospinal irradiation is feasible for standard-risk adult medulloblastoma patients. J Neurooncol 148, 619–628 (2020). https://doi.org/10.1007/s11060-020-03564-y

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