Desmoplastic Medulloblastoma Patients Survival after Multimodality Treatment

Aims: This is to investigate the results of the multimodality regimen including surgery, postoperative craniospinal irradiation and clarify the role of chemotherapy as well as the influence of multiple variables on desmoplastic medulloblastoma patient’s survival.

Study Design: Original research papers.

Place and Duration of Study: It took place in the period between January 2001 and Sept 2015 at Neurosurgery and Clinical Oncology & Nuclear Remedies Departments of Mansoura university Hospital.

Methodology: We reviewed data of (28) patients histological confirmed as desmoplastic medulloblastoma (17 male beside 11 female) including clinical history, examination, investigation and management.

Results: The median age was 17.8 years, (range 3-41) with male to female ratio was (1.5:1). The most dominating symptoms were vomiting (82%) and throbbing headache (71.4%). The positioning of tumor was lateral in 64.3% and midline in 35.7%. The total resection of the tumor was achieved in 17 (60.7%) patients. All patients received craniospinal irradiation. The median dosage to the posterior fossa was 54 Gy (range 49- 56 Gy). 71.4% of the patients received adjuvant chemotherapy. The median follow-up was 52.3 months (range 25 -120). Five years’ overall survival rates were 71.4% and 67.8% respectively.8 patients developed relapse. Posterior fossa was the commonest site for relapse (21.4%). Brain stem infiltration was bad prognostic factor (p= 0.006). The extent of surgical resection can be considered a good prognostic factor (p=0.004). Age, sex and tumor location did not significantly affect the results of survival. One of the most reported side effect was substantially, sensory neuropathy, nausea, vomiting, fever and neutropenia.

Conclusion: Patients with desmoplastic medulloblastoma being given chemotherapy adjuvant to surgical resection and radiotherapy (Multimodality approach) remain alive longer than patients who had management of surgery and radiotherapy only although brain stem infiltration, large post-operative residual are often associated with poor prognosis.