Primary therapy of medulloblastoma with surgery, radiation and methotrexate and BCNU — A pilot study
From 1976 to 1981, 15 patients, aged 2½ to 22 years, with histologically proven medulloblastoma were treated in a pilot study with surgical resection, craniospinal irradiation and one year of adjuvant chemotherapy with intermediate dose methotrexate (500mg/m2) and BCNU (100 mg/m2). Nine out of 15 patients (60%) are disease-free 27 months to 84 months (median 41 months) from diagnosis. Six patients relapsed at 7, 17, 19, 27, 28, and 31 months and they all died from disease. The degree of initial surgical resection is of prognostic importance. Six out of 7 patients (86%) who had grossly complete resection are alive without disease at 39 to 84 months (median 53 months) from diagnosis, whereas only 3 out of 8 patients (38%) who had incomplete resection of tumor are disease-free at 27, 39, and 83 months from diagnosis (p(2) = 0.07, Cox Mantel test). The chemotherapy was well tolerated without major toxicity (in particular leukoencephalopathy). Intermediate dose methotrexate appears to be a suitable agent for future preradiotherapy chemotherapy trials for medulloblastoma, especially for those patients at high risk for relapse.
Key wordsmedulloblastoma surgery craniospinal irradiation methotrexate BCNU
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