| Popis: |
New radiotherapy modalities, 3D-conformal radiation therapy (CRT) and IMRT allow including the radiotherapy for medulloblastoma younger than 36 months. The aim is to evaluate the results of chemotherapy plus 3D-CRT/IMRT in infants nonmetastatic medulloblastoma. From October 2002 to November 2016, 38 infants medulloblastoma patients were treated in our institution, 9 metastatic; 26 of 29 nonmetastatic patients were evaluable. After initial surgery, children received 5 cycles of induction chemotherapy, including Vincristine(0.05mg/k/d1,8,15)/Cisplatin(3.5mg/k/d1)/Cyclophosphamide(30mg/k/d2,3)/Etoposide(4mg/k/d2,3), followed by four maintenance cycles: Carboplatin(18mg/k/d1)/Vincristine(0.05mg/k/d1,28)/Cyclophosphamide(50mg/k/d28)/Etoposide(1,6mg/k/d2-14;29-43orally). Posterior fossa 3D-CRT or bed tumor IMRT with/without Temozolamide was indicated after induction or when achieved 18 months(54/55.8Gy). Median age at diagnosis was 24.8m(3.1-55.4). The histological subtypes were: 10pt classic, 15pt desmoplastic/nodular, 1pt extensive nodularity. 4pt had gross residual tumor. 23pt received 3D-CRT/IMRT. The median time from resection to radiotherapy was 5.9m(5.09-25.3). The median age of 3D-CRT/IMRT was 33.9m(18.3-60.4). 3pt did not receive CRT; 2 death on induction and 1 extensive nodularity. The median follow up was 47.7m(6.3-183). The 5 year event-free survival and overall survival probabilities were 64% and 72% respectively. 7 pt relapsed; 1 supratentorial, 1 intraventicular, 4 leptomeningeal and 1 spinal space. Median time from diagnosis to relapse was 13.9m(5.6-25). 2pt had second malignant neoplasm in irradiated area; 1 osteosarcoma(+118m) and 1 undifferentiated sarcoma(+71 m). The results obtained in this particular group of patients are very encouraging, considering to be similar to older patients with craniospinal radiotherapy. This suggests that this protocol treatment can be use as first line for patients into 3-6 years old to reduce the radiotherapy sequelae. |
