Summary
Forty-seven children with histologically confirmed medulloblastoma are considered. Forty-five cases were surgically treated by direct approach to the tumour, while two cases were treated only with a shunt. A shunt was inserted preoperatively in 14 cases, postoperatively in 4 cases. Surgical resection was total or subtotal in 52% of cases, partial in 35%, and limited to a biopsy in 13%. Radiation treatment to the entire neuraxis was done in 37 cases: 10 of these cases received additional chemotherapy—mostly with CCNU—as primary treatment for medulloblastoma.
Ten patients died within 30 days after surgery. Twenty-two patients died months after treatment, mainly from tumour recurrence (19 cases). One patient was lost to follow-up. Thirteen patients are survivors from 10 months to 20 years after treatment. As a whole, the one year survival rate has been 67%, 3 year survival 43%, and 5 year survival 27%. Complications affecting prognosis have been presented by tumour recurrence and metastases. CSF shunting and lack of prophylactic irradiation to the cerebral hemispheres have been considered responsible for the high incidence of supratentorial metastases in our series.
Factors influencing prognosis have been the extent of tumour resection and association of primary chemotherapy with radiotherapy. Within 3 years after surgery survival has been 52% in cases with total resection against 31% in cases with partial resection of tumour. As regards chemotherapy, 3 year survival has been 60% for patients with combined treatment (chemo- and radiotherapy) against 37% in patients with radiotherapy alone. It is concluded that the best results in children with medulloblastoma are achieved by a radical resection, associated with a combined primary treatment of radiotherapy and chemotherapy.
Similar content being viewed by others
References
Albright, L., Reigel, D. H., Management of hydrocephalus secondary to posterior fossa tumors. J. Neurosurg.46 (1977), 52–55.
Aron, B. S., Medulloblastoma in children. Twenty-two years' experience with radiation therapy. Amer. J. Dis. Child.121 (1971), 314–317.
Bailey, P., Cushing, H., Medulloblastoma cerebelli: a common type of midcerebellar glioma of childhood. Arch. Neurol. Psychiat. (Chicago)14 (1925), 192–224.
Black, S. P. W., Keats, T. E., Generalized osteosclerosis secondary to metastatic medulloblastoma of the cerebellum. Radiology82 (1964), 395–400.
Bloom, H. J. G., Combined modality therapy for intracranial tumors. Cancer35 (1975), 111–120.
Bloom, H. J. G., Wallace, E. N. K., Henk, J. M., The treatment and prognosis of medulloblastoma in children. A study of 83 verified cases. Amer. J. Roentgenol.105 (1969), 43–62.
Bongartz, E. B., Bamberg, M., Nau, H. E., Schmitt, G., Bayindir, C., Optimal therapy in medulloblastoma. Acta neurochir. (Wien)50 (1979), 117–125.
Brutschin, P., Culver, G. J., Extracranial metastases from medulloblastomas. Radiology107 (1973), 359–362.
Crafts, D. C., Levin, V. A., Edwards, M. S., Pischer, T. L., Wilson, C. B., Chemotherapy of recurrent medulloblastoma with combined procarbazine, CCNU, and vincristine. J. Neurosurg.49 (1978), 589–592.
Crist, W. M., Ragab, A. H., Vietti, T. J., Ducos, R., Chu, J. Y., Chemotherapy of childhood medulloblastoma. Amer. J. Dis. Child.130 (1976), 639–642.
Cushing, H., Experiences with cerebellar medulloblastoma. A critical review. Acta Path. Microbiol. Scand.7 (1930), 1–86.
Das, S., Dalby, J. E., Distant metastases from medulloblastoma. Acta Radiol. (Ther.)16 (1977), 117–123.
Debnam, J. W., Staple, T. W., Osseous metastases from cerebellar medulloblastoma. Radiology107 (1973), 363–365.
Hardy, D. G., Hope-Stone, H. F., McKenzie, C. G., Scholtz, C. L., Recurrence of medulloblastoma after homogeneous field radiotherapy. Report of three cases. J. Neurosurg.49 (1978), 434–440.
Hekmatpanah, J., Mullan, S., Ventriculo-caval shunt in the management of posterior fossa tumors. J. Neurosurg.26 (1967), 609–613.
Hemmer, R., Haensel-Friedrich, G., Friedrich, H., The value of preoperative shunts in posterior fossa tumors. In: Mod. Probl. Paediat., Vol. 18: Pediatric Neurosurgery, pp. 48–50 (Villani, R.,et al., eds.). Basel: Karger. 1977.
Hirsch, J. F., Renier, D., Czernichow, P., Benveniste, L., Pierre-Kahn, A., Medulloblastoma in childhood. Survival and functional results. Acta neurochir. (Wien)48 (1979), 1–15.
Hoffman, H. J., Hendrick, E. B., Humphreys, R. P., Metastasis via ventriculoperitoneal shunt in patients with medulloblastoma. J. Neurosurg.44 (1976), 562–566.
Hope-Stone, H. F., Results of treatment of medulloblastomas. J. Neurosurg.32 (1970), 83–88.
Humphreys, R. P., Creighton, R. E., Hendrick, E. B., Hoffman, H. J., Advantages of the prone position for neurosurgical procedures on the upper cervical spine and posterior cranial fossa in children. Child's Brain1 (1975), 325–336.
Jane, J. A., Kaufman, B., Nulsen, F., Yashon, D., Young, H., The role of angiography and ventriculovenous shunting in the treatment of posterior fossa tumors. Acta neurochir. (Wien)28 (1973), 13–27.
Jenkin, R. D. T., Medulloblastoma in childhood: Radiation therapy. Canad. Med. Ass. J.100 (1969), 51–53.
Kessler, L. A., Dugan, P., Concannon, J. P., Systemic metastases of medulloblastoma promoted by shunting. Surg. Neurol.3 (1975), 147–152.
King, G. A., Sagerman, R. H., Late recurrence in medulloblastoma. Amer. J. Roentgenol.123 (1975), 7–12.
Knerich, R., Adinolfi, D., Buoncristiani, P., Butti, G., Calculli, G., Cordero, L., Madon, E., Mazza, C., Tanghetti, B., Tarenzi, L., Combined therapy for malignant brain tumors in children. J. Neurosurg. Sci.23 (1979), 273–278.
Lampe, I., MacIntyre, R. S., Experience in the radiation therapy of medulloblastoma of the cerebellum. Amer. J. Roentgenol.71 (1954), 659–668.
Lampkin, B. C., Mauer, A. M., McBride, B. H., Response of medulloblastoma to vincristine sulfate: a case report. Pediatrics39 (1967), 761–763.
Lassman, L. P., Diagnosis and management of skeletal metastases from cerebellar medulloblastoma. Child's Brain2 (1976), 38–45.
Lassman, L. P., The treatment of posterior fossa tumors in childhood. In: Mod. Probl. Paediat., Vol. 18: Pediatric Neurosurgery, pp. 12–22 (Villani, R.,et al., eds.). Basel: Karger. 1977.
Makeever, L. C., King, J. D., Medulloblastoma with extracranial metastases through a ventricular venous shunt. Amer. J. Clin. Path.46 (1966), 245–249.
Matson, D., Tumors of the posterior fossa. In: Neurosurgery of infancy and childhood (second edition), chapter 27, pp. 410–479. Springfield, Ill: Ch. C Thomas. 1969.
McFarland, D. R., Horwitz, H., Saenger, E. L., Bahr, G. K., Medulloblastoma -a review of prognosis and survival. Brit. J. Radiol.42 (1969), 198–214.
McIntosh, N., Medulloblastoma—a changing prognosis? Arch. Dis. Child.54 (1979), 200–203.
Mealey, J., Hall, P. V., Medulloblastoma in children. Survival and treatment. J. Neurosurg.46 (1977), 56–64.
Paterson, E., Farr, R. F., Cerebellar medulloblastoma: treatment by irradiation of the whole central nervous system. Acta Radiol.39 (1953), 323–336.
Quest, D. O., Brisman, R., Antunes, J. L., Housepian, E. M., Period of risk for recurrence in medulloblastoma. J. Neurosurg.48 (1978), 159–163.
Raimondi, A. J., Tomita, T., Medulloblastoma in childhood. Comparative results of partial and total resection. Child's Brain5 (1979), 310–328.
Raimondi, A. J., Tomita, T., Medulloblastoma in childhood. Acta neurochir. (Wien)50 (1979), 127–138.
Rosenstock, J. G., Evans, A. E., Schut, L., Response to vincristine of recurrent brain tumors in children. J. Neurosurg.45 (1976), 135–140.
Rubinstein, L. J., Tumors of the central nervous system. In: Atlas of tumor pathology. Second series, fascicle 6, p. 148 (Firminger, H. I., ed.). Washington, D.C.: Armed Forces Institute of Pathology. 1970.
Shapiro, W. R., Chemotherapy of primary malignant brain tumors in children. Cancer35 (1975), 965–972.
Shapiro, W. R., Chernik, N. L., Posner, J. B., Necrotizing encephalopathy following intraventricular instillation of methotrexate. Arch. Neurol.28 (1973), 96–102.
Sheline, G. E., Radiation therapy of tumors of the central nervous system in childhood. Cancer35 (1975), 957–964.
Smith, C. E., Long, D. M., Jones, T. K., Levitt, S. H., Medulloblastoma: an analysis of time-dose relationships and recurrence patterns. Cancer32 (1973), 722–728.
Smith, R. A., Lampe, I., Kahn, E. A., The prognosis of medulloblastoma in children. J. Neurosurg.18 (1961), 91–97.
Venes, J. L., McIntosh, S., O'Brien, R. T., Schwartz, A. D., Chemotherapy as an adjunct in the initial management of cerebellar medulloblastomas. A preliminary report. J. Neurosurg.50 (1979), 721–724.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mazza, C., Pasqualin, A., Da Pian, R. et al. Treatment of medulloblastoma in children: Long-term results following surgery, radiotherapy and chemotherapy. Acta neurochir 57, 163–175 (1981). https://doi.org/10.1007/BF01664835
Issue Date:
DOI: https://doi.org/10.1007/BF01664835