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The clinical experience of medulloblastoma treatment and the significance of time sequence for development of leptomeningeal metastasis

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Abstract

Objects

Among patients with medulloblastoma, an unrare aggressive central nervous system (CNS) tumor found mostly in the posterior fossa, drop metastasis from primary location to anatomically lower sites including whole spinal cord is known as a potential way for tumor to spread. There were already lots of extensive discussions regarding diagnosis and treatment for such common neurologic complication in systemic cancer; however, fewer were found about medulloblastoma. This study aimed to reexamine the possible known prognostic factors, especially drop metastasis, and defined the influence of them.

Materials and methods

We retrospectively review a series of 36 patients who suffered from posterior fossa medulloblastoma and found leptomeningeal metastasis in 12 of them. Incidence, diagnosis, prognostic factors, and treatments for this common complication are discussed. The magnetic resonance images (MRI) of these patients were reviewed. The time sequence between primary surgical procedure and development of MRI evidences of drop metastasis was used for subgrouping. Log-rank test was used for survival analysis.

Conclusions

By survival analysis, patients with late drop metastasis, defined as new radiologic evidence of leptomeningeal involvement after primary CNS procedures, were found to have significant survival difference to those with early metastasis defined as drop metastasis found at the time of diagnosis (log-rank test, p = 0.0047). Further stratification of patients within this group may help in evaluation of prognosis and development of different treatment strategies.

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Authors and Affiliations

  1. Department of Neurosurgery, Chang Gung Memorial Hospital, No. 5, Fu-Shin Street, Kwei-Shan, Taoyuan, 333, Taiwan, Republic of China

    Po-Chuan Hsieh, Chieh-Tsai Wu & Tai-Ngar Lui

  2. Department of Pediatric Neurology, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan, Republic of China

    Kuang-Lin Lin

  3. Department of Pediatric Oncology, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan, Republic of China

    Tang-Her Jaing

  4. Department of Radio-oncology, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan, Republic of China

    Chen-Kan Tseng

  5. Department of Pathology, Chung-Gung Memorial Hospital, No. 5, Fu-Shin Street, Kwei-Shan, Taoyuan, 333, Taiwan, Republic of China

    Shih-Ming Jung

Authors
  1. Po-Chuan Hsieh
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  2. Chieh-Tsai Wu
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  3. Kuang-Lin Lin
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  4. Tang-Her Jaing
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  5. Chen-Kan Tseng
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  6. Tai-Ngar Lui
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  7. Shih-Ming Jung
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Correspondence to Chieh-Tsai Wu.

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Hsieh, PC., Wu, CT., Lin, KL. et al. The clinical experience of medulloblastoma treatment and the significance of time sequence for development of leptomeningeal metastasis. Childs Nerv Syst 24, 1463–1467 (2008). https://doi.org/10.1007/s00381-008-0697-2

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  • DOI: https://doi.org/10.1007/s00381-008-0697-2

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