Abstract
Thirty children with medulloblastoma who were treated between 1980 and 1986 are presented. Flow cytometric DNA analysis using formalin-fixed and paraffin-embedded tissues showed that 15 were DNA aneuploid,13 diploid and 2 tetraploid. After homogeneous treatment with a combination of radical resection and radiation therapy, patients with DNA aneuploid medulloblastoma showed significantly better outcome (p = 0.003).
Among these 30 patients, 6 (20%) had bone metastases of medulloblastoma during a minimum of 2-year follow-up period. DNA ploidy of these patients was diploid in 5 and aneuploid in 1. Incidence of bone metastases appears to correlate with DNA ploidy (p = 0.046). At the time of discovery of bone metastases, 4 had no demonstrable recurrence in the central nervous system (CNS). Radionuclide bone scan was more sensitive in disclosing these lesions, while only one patient had positive results of bone marrow aspirates/ biopsy. Three patients were treated with chemotherapy, two had a combination of regional irradiation and chemotherapy and one refused treatment. All treated bone metastases in 5 patients responded clinically and radiographically, but only one patient is alive 66 months after therapy. Four patients died due to either CNS recurrence or septic complication of chemotherapy. Early detection of bone metastases by use of frequent bone scans is important. Patients with diploid medulloblastoma should be treated with adjuvant chemotherapy in order to prevent recurrences and metastases.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Tomita T, McLone DG: Medulloblastoma in childhood: Results of radical resection and low-dose neuraxis radiation therapy. J. Neurosurg 64: 238–242, 1986
Caputy AJ, McCullough DC, Manz HJ, Patterson K, Hammock MK: A review of the factors influencing the prognosis of medulloblastoma; The importance of cell differentiation. J. Neurosurg 66: 80–87, 1987
Taomoto K, Tomita T, Raimondi AJ, Leestma JE: Medulloblastomas in childhood: histological factors influencing patients' outcome. Child's Nerv Syst 3: 354–360, 1987
Raimondi AJ, Tomita T: Medulloblastoma in childhood: comparative results of partial and total resection. Childs Brain 5: 310–328, 1979
Kleinman GM, Hochberg FH, Richardson EP: Systemic metastases from medulloblastoma: report of two cases and review of the literature. Cancer 48: 2296–2309, 1981
Brutschin P, Culver GJ: Extracranial metastases from medulloblastomas. Radiology 107: 359–362, 1973
Tomita T, Yasue M, Engelhard HH, McLone DG, Gonzalez-Crussi F, Bauer KD: Flow cytometric DNA analysis of medulloblastoma. Prognostic implication of aneuploidy. Cancer 61: 744–749, 1988
Yasue M, Tomita T, Engelhard H, Gonzalez-Crussi F, McLone DG Bauer KD: Prognostic importance of DNA ploidy in medulloblastoma of childhood. J Neurosurg. 70: 385–391, 1989
Campbell AN, Chan HSL, Becker LE, Daneman A, Park TS, Hoffman HJ: Extracranial metastases in childhood primary intracranial tumors. A report of 21 cases and review of the literature. Cancer 53: 974–981, 198
Hoffman HJ, Duffner P: Extraneural metastases of central nervous system tumors. Cancer 56: 1778–1782, 1985
McComb JG, Davis RL, Issacs H, Landing BH: Medulloblastoma presenting as neck tumors in 2 infants. Ann Neurol 7: 113–117, 1980
Hoffman HJ, Hendrick EB, Humphreys RP: Metastasis via ventriculoperitoneal shunt in patients with medulloblastoma. J Neurosurg 44: 562–566, 1976
Oberman HA, Hewitt WC Jr, Kalivoda AJ: Medulloblastomas with distant metastases. Amer J Clin Pathol 39: 148–160, 1963
Allen JC, Epstein F: Medulloblastoma and other primary malignant neuroectodermal tumors of the CNS. The effect of patient's age and extent of disease on prognosis. J Neurosurg 57: 446–451, 1982
Black SPW, Keats TE: Generalized osteosclerosis secondary to metastatic medulloblastoma of the cerebellum. Radiology 82: 395–400, 1964
Drachman DA, Winters TS, Karon M: Medulloblastoma with extracranial metastases. Arch Neurol 9: 518–530, 1963
Spencer CD, Weiss RB, Van Eys J, Cohen P, Edwards B: Medulloblastoma metastatic to the marrow. Report of four cases and review of the literature. J Neuro-oncology 2: 223–235, 1984
Duffner PK, Cohen ME: Extraneural metastases in childhood brain tumors. Ann Neurol 10: 261–265, 1981
Taylor SR, Blatt J, Costantino JP, Roederer M, Murphy RF: Flow cytometric DNA analysis of neuroblastoma and ganglioneuroma. A 10-year retrospective study. Cancer 62: 749–754, 1988
Oppodal BR, Storm-Mathisen I, Lie SO, Brandtzaeg P: Prognostic factors in neuroblastoma. Clinical, histopathologic, and immunohistochemical features and DNA ploidy in relation to prognosis. Cancer 62: 772–780, 1988
Gansler T, Chatten J, Varello M, Bunin GR, Atkinson B: Flow cytometric DNA analysis of neuroblastoma: correlation with histology and clinical outcome. Cancer 58: 2453–2458, 1986
Look AT, Hayes FA, Nitscke R, McWilliams NB, Green AA: Cellular DNA content as a predictor of response to chemotherapy in infants with unresectable neuroblastoma. N Eng J Med 311: 231–235, 1984
Williams DL, Tsiatis A, Brodeur GM et al.: Prognostic importance of chromosome ploidy in 136 untreated children with acute lymphoblastic leukemia. Blood 60: 864–871, 1982
Debnam JW, Staple TW: Osseous metastases from cerebellar medulloblastoma. Radiology 107: 363–365, 1973
Nathanson L, Kovacs SG: Chemotherapeutic response in metastatic medulloblastoma. Report of two cases and a review of literature. Med Ped Oncology 4: 105–110, 1978 Abstract
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Tomita, T., Das, L. & Radkowski, M.A. Bone metastases of medulloblastoma in childhood; correlation with flow cytometric DNA analysis. J Neuro-Oncol 8, 113–120 (1990). https://doi.org/10.1007/BF00177833
Issue Date:
DOI: https://doi.org/10.1007/BF00177833