Adjuvant chemotherapy in average-risk adult medulloblastoma patients improves survival: a long term study

Abstract

Background : The role of chemotherapy for average-risk adult patients remains controversial. Medulloblastoma is extremely rare in adults. Radical surgery and radiotherapy provide a significant control of disease and a good prognosis but about 25% of average-risk patients have a relapse and die because of disease progression. No data in average-risk adult patients on a direct comparison between radiotherapy alone and radiotherapy plus chemotherapy Methods : We analyzed 48 average-risk patients according to Chang classification diagnosed from 1988 to 2016. Results : Median age was 29 years (range 16-61). Main histology type were classic in 15 patients (31.3%) and desmoplastic in 15 patients (31.3%), 5 patients had extensive nodularity (10.4%) and 2 patients had large cells/anaplastic histology (4.2%). Twenty-four patients (50%) received adjuvant radiotherapy alone and 24 (50%) received radiotherapy and chemotherapy. After a median follow-up of 12.5 years, we found that chemotherapy increases PFS (PFS-15 82.3 ± 8.0% in RT-CT group vs. 38.5% ± 13.0% in RT group p=0.05) and OS (OS-15 89.3% 7.2% vs. 52.0% 13.1%, p=0.02). Among patients receiving chemotherapy, the reported grade ≥ 3 adverse events were: 9 cases of neutropenia; 6 cases of G3 neutropenia (25%) and 3 cases of G4 neutropenia (13%), 1 case of G3 thrombocytopenia (4%) and 2 cases of G3 nausea (8%). Conclusions : Our study with a long follow up period suggests that adding adjuvant chemotherapy to radiotherapy might improve PFS and OS in average-risk adult medulloblastoma patients