Metastatic medulloblastoma in adults: Outcome of patients treated according to the HIT2000 protocol
Autor: | Monika Warmuth-Metz, Rolf D. Kortmann, Joachim Kuehl, Peter Hau, André O. von Bueren, Torsten Pietsch, Stefan Rutkowski, Klaus J. Müller, Carsten Friedrich, Robert Kwiecien, Martin Benesch, Katja von Hoff |
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Rok vydání: | 2015 |
Předmět: |
Adult
Male Oncology Cancer Research medicine.medical_specialty Time Factors medicine.medical_treatment Kaplan-Meier Estimate Disease-Free Survival Neurosurgical Procedures Maintenance Chemotherapy Anaplastic Medulloblastoma Ototoxicity Risk Factors Germany Internal medicine medicine Humans Prospective Studies Cerebellar Neoplasms Prospective cohort study Medulloblastoma Chemotherapy business.industry Desmoplastic medulloblastoma Age Factors Dose fractionation Chemoradiotherapy Adjuvant medicine.disease 3. Good health Surgery Radiation therapy Treatment Outcome Austria Disease Progression Female Dose Fractionation Radiation Cranial Irradiation business |
Zdroj: | European Journal of Cancer. 51:2434-2443 |
ISSN: | 0959-8049 |
Popis: | Background Due to the rarity of metastatic medulloblastoma in adults, knowledge about the efficacy and toxicity of intensified chemotherapy and radiotherapy is limited. Patients and methods Adults with disseminated medulloblastoma registered in the HIT2000 trial as observational patients and treated according to one of two different treatment regimens were analysed. The sandwich strategy MET-HIT2000AB4 consists of postoperative chemotherapy, hyperfractionated craniospinal radiotherapy, and maintenance chemotherapy; while the HIT′91 maintenance strategy consists of postoperative craniospinal radiotherapy, and maintenance chemotherapy. Results Twenty-three patients (median age: 30.7 years), diagnosed from November 2001 to July 2009, and treated in 18 institutions in Germany and Austria, were eligible. The median follow-up of surviving patients was 3.99 years. The 4-year event-free survival (EFS) and overall survival (OS) ± standard error (SE) were 52% ± 12% and 91% ± 6%, respectively. The survival was similar in both treatment groups (HIT′91 maintenance strategy, n = 9; MET-HIT2000AB4 sandwich strategy, n = 14). Patients with large cell/anaplastic medulloblastoma relapsed and died (n = 2; 4-year EFS/OS: 0%) and OS differed compared to patients with classic (n = 11; 4-year EFS/OS: 71%/91%) and desmoplastic medulloblastoma (n = 10; 4-year EFS/OS: 48%/100%), respectively (p = 0.161 for EFS and p = 0.033 for OS). Treatment-induced toxicities consisted mainly of neurotoxicity (50% of patients, ⩾ °II), followed by haematotoxicity and nephrotoxicity/ototoxicity. The professional outcome appeared to be negatively affected in the majority of evaluable patients (9/10). Conclusions Treatment of adults with metastatic medulloblastoma according to the intensified paediatric HIT2000 protocol was feasible with acceptable toxicities. EFS rates achieved by both chemotherapeutic protocols were favourable and appear to be inferior to those obtained in older children/adolescents with metastatic disease. |
Databáze: | OpenAIRE |
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