Skip to main content
SpringerLink
Log in

The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature

  • Clinical Study - Patient Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 07 September 2011

Abstract

Medulloblastoma (MB) occurs infrequently in adult patients and standard treatment is still controversial. We report our long-term, single-institution experience of adult MB and a review of the literature. We analysed adult patients with histologically proved MB treated by postoperative radiotherapy. Primary endpoints were local control (LC), disease-free survival (DFS), and overall survival (OS). Acute toxicity was reported according to CTC-NCI score vers. 3.0 and specific neuropsychological assessment analysis was performed to define late brain toxicity. From 1990–2008, 13 patients were treated by craniospinal (CSI, 12/13) or cranial irradiation (1/13, because of bad clinical conditions). Median follow up was 101 months (64–218). Complete radiological response was observed in 12/13 patients and a partial response in 1/13. Ten-year LC, OS, and DFS were 91, 76, and 84%, respectively. Two patients died because of local and spinal progression after 13 and 62 months. Acute G3 haematological toxicity (RTOG score) was observed for one patient only. The neuropsychological analysis did not reveal late toxicity related to brain radiotherapy. This experience confirms the efficacy and safety of radiotherapy in adult MB patients, resulting in very interesting 10-year LC and OS.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Giordana MT, Schiffer P, Lanotte M, Girardi P, Chio A (1999) Epidemiology of adult medulloblastoma. Int J Cancer 80:689–692

    Article  PubMed  CAS  Google Scholar 

  2. Frost PJ, Laperriere NJ, Wong CS, Milosevic MF, Simpson WJ, Pintilie M (1995) Medulloblastoma in adults. Int J Radiat Oncol Biol Phys 32:951–957

    Article  PubMed  CAS  Google Scholar 

  3. Chang CH, Housepian EM, Herbert C Jr (1969) An operative staging system and a megavoltage radiotherapeutic technique for cerebellar medulloblastoma. Radiology 93:1351–1359

    PubMed  CAS  Google Scholar 

  4. Mammarella IC, Toso C, Pazzaglia F, Cornoldi C (2005) BVS-Corsi: batteria per la valutazione della memoria visiva e spaziale. Erickson, Trento

    Google Scholar 

  5. Luria AR (1973) The working brain. Penguin Press, London

    Google Scholar 

  6. Rey A (1968) Reattivo della figura complessa. Organizzazioni Speciali, Firenze, pp 25–40

  7. Krikorian R, Bartok J, Gay N (1994) Tower of London procedure: a standard method and developmental data. J Clin Exp Neuropsychol 16(6):840–850

    Article  PubMed  CAS  Google Scholar 

  8. Borkowsky JG, Benton AL, Spreen O (1967) Word fluency and brain damage. Neuropsychologia 5:135–140

    Article  Google Scholar 

  9. Kertesz A, Nadkarni N, Davidson W, Thomas AW (2000) The frontal behavioral inventory in the differential diagnosis of frontotemporal dementia. J Int Neuropsychol Soc 6(4):460–468

    Article  PubMed  CAS  Google Scholar 

  10. Miceli G, Laudanna A, Burani C, Capasso R. (1994) Manuale per l’analisi dei deficit afasici. Universita` Cattolica del Sacro Cuore, Consiglio Nazionale delle Ricerche, Roma

  11. American Association on Mental Retardation (AAMR) (2002) Mental retardation: definition, classification and system of support, 10th edn. Library of Congress, Washington DC

    Google Scholar 

  12. Association American Psychiatric (2000) DSM-IV-TR: diagnostic and statistical manual of mental disorders, 4th edn. Text revision. Masson, Milan, pp 31–291

  13. Oldfield RC (1971) The assessment and analysis of handedness: the Edinburgh Inventory. Neuropsychologia 9:97–113

    Article  PubMed  CAS  Google Scholar 

  14. Gainotti G, Miceli G, Caltagirone C (1977) Constructional apraxia in left brain-damaged patients: A planning disorders? Cortex 13:109–118

    PubMed  CAS  Google Scholar 

  15. Carlesimo GA, Caltagirone C, Gainotti G (1996) The mental deterioration battery: normative data, diagnostic reliability and qualitative analyses of cognitive impairment. Eur Neurol 36:378–384

    Article  PubMed  CAS  Google Scholar 

  16. Korshunov A, Remke M, Werft W, Benner A, Ryzhova M, Witt H, Sturm D, Wittmann A, Schöttler A, Felsberg J, Reifenberger G, Rutkowski S, Scheurlen W, Kulozik AE, von Deimling A, Lichter P, Pfister SM (2010) Adult and pediatric medulloblastomas are genetically distinct and require different algorithms for molecular risk stratification. J Clin Oncol 28(18):3054–3060 Epub 2010 May 17

    Article  PubMed  Google Scholar 

  17. Padovani L, André N, Carrie C, Muracciole X (2009) Childhood and adult medulloblastoma: What difference? Cancer Radiother 13(6–7):530–535

    Article  PubMed  CAS  Google Scholar 

  18. Curran EK, Le GM, Sainani KL, Propp JM, Fisher PG (2009) Do children and adults differ in survival from medulloblastoma? A study from the SEER registry. J Neurooncol 95(1):81–85

    Article  PubMed  Google Scholar 

  19. Packer RJ, Goldwein J, Nicholson HS, Vezina LG, Allen JC, Ris MD, Muraszko K, Rorke LB, Wara WM, Cohen BH, Boyett JM (1999) Treatment of children with medulloblastomas with reduced-dose craniospinal radiation therapy and adjuvant chemotherapy: a children’s cancer group study. J Clin Oncol 17:2127–2136

    PubMed  CAS  Google Scholar 

  20. Warmuth-Metz M, Blashofer S, von Bueren AO, von Hoff K, Bison B, Pohl F, Kortmann RD, Pietsch T, Rutkowski S. (Nov 2010) Recurrence in childhood medulloblastoma. J Neurooncol. 2010 Nov 11

  21. Brandes AA, Palmisano V, Monfardini S (1999) Medulloblastoma in adults: clinical characteristics and treatment. Cancer Treat Rev 25:3–12

    Article  PubMed  CAS  Google Scholar 

  22. Brandes AA, Paris MK (2004) Review of the prognostic factors in medulloblastoma of children and adults. Crit Rev Oncol Hematol 50:121–128

    Article  PubMed  Google Scholar 

  23. Lai R (2008) Survival of patients with adult medulloblastoma: a population-based study. Cancer 112(7):1568–1574

    Article  PubMed  Google Scholar 

  24. Brandes AA, Franceschi E, Tosoni A, Blatt V, Ermani M (2007) Long-term results of a prospective study on the treatment of medulloblastoma in adults. Cancer 110(9):2035–2041

    Article  PubMed  Google Scholar 

  25. Giordana MT, Cavalla P, Chiò A, Marino S, Soffietti R, Vigliani MC, Schiffer D (1995) Prognostic factors in adult medulloblastoma. A clinico-pathologic study. Tumori 81:338–346

    PubMed  CAS  Google Scholar 

  26. Noel G, Merrer J (1997) Medulloblastoma in adults. Val-de-Grace hospital experience (1975–1994) and literature review. Cancer Radiother 1:60–67

    Article  PubMed  CAS  Google Scholar 

  27. Prados MD, Warnick RE, Wara WM, Larson DA, Lamborn K, Wilson CB (1995) Medulloblastoma in adults. Int J Radiat Oncol Biol Phys 32:1145–1152

    Article  PubMed  CAS  Google Scholar 

  28. Abacioglu U, Uzel O, Sengoz M, Turkan S, Ober A (2002) Medulloblastoma in adults: treatment results and prognostic factors. Int J Radiat Oncol Biol Phys 54:855–860

    Article  PubMed  Google Scholar 

  29. Chan AW, Tarbell NJ, Black PM, Louis DN, Frosch MP, Ancukiewicz M, Chapman P, Loeffler JS (2000) Adult medulloblastoma: prognostic factors and patterns of relapse. Neurosurgery 47:623–631

    PubMed  CAS  Google Scholar 

  30. Kunschner LJ, Kuttesch J, Hess K, Yung WK (2001) Survival, recurrence factors in adult medulloblastoma: the M.D. Anderson Cancer Center experience from 1978 to 1998. Neurooncology 3:167–173

    CAS  Google Scholar 

  31. Malheiros SM, Franco CM, Stávale JN, Santos AJ, Borges LR, Pelaez MP, Ferraz FA, Gabbai AA (2002) Medulloblastoma in adults: a series from Brazil. J Neurooncol 60:247–253

    Article  PubMed  Google Scholar 

  32. Carrie C, Lasset C, Alapetite C, Haie-Meder C, Hoffstetter S, Demaille MC, Kerr C, Wagner JP, Lagrange JL, Maire JP et al (1994) Multivariate analysis of prognostic factors in adult patients with medulloblastoma. Cancer 74:2352–2360

    Article  PubMed  CAS  Google Scholar 

  33. Hartsell WF, Montag AG, Lydon J, Galinsky DL, Sarin P (1992) Treatment of medulloblastoma in adults. Am J Clin Oncol 15:207–211

    Article  PubMed  CAS  Google Scholar 

  34. Skolyszewski J, Glinski B (1989) Results of postoperative irradiation of medulloblastoma in adults. Int J Radiat Oncol Biol Phys 16:479–482

    Article  PubMed  CAS  Google Scholar 

  35. Boiardi A, Silvani A, Eoli M, Fariselli L, Zappacosta B, Salmaggi A (2000) Embryonal tumors in the adult population: implications in therapeutic planning. Neurol Sci 21:23–30

    Article  PubMed  CAS  Google Scholar 

  36. Hazuka MB, DeBiose DA, Henderson RH, Kinzie JJ (1992) Survival results in adult patients treated for medulloblastoma. Cancer 69:2143–2148

    Article  PubMed  CAS  Google Scholar 

  37. Coulbois S, Civit T, Grignon Y, Taillandier L, Girard F, Marchal C, Pinelli C, Auque J (2001) Adult medulloblastoma: review of 22 patients. Neurochirurgie 47:6–12

    PubMed  CAS  Google Scholar 

  38. Haie C, Schlienger M, Constans JP, Meder JF, Reynaud A, Ghenim C (1985) Results of radiation treatment of medulloblastoma in adults. Int J Radiat Oncol Biol Phys 11:2051–2056

    Article  PubMed  CAS  Google Scholar 

  39. Le QT, Weil MD, Wara WM, Lamborn KR, Prados MD, Edwards MS, Gutin PH (1997) Adult medulloblastoma: an analysis of survival and prognostic factors. Cancer J Sci Am 3:238–245

    PubMed  CAS  Google Scholar 

  40. Greenberg HS, Chamberlain MC, Glantz MJ, Wang S (2001) Adult medulloblastoma: multiagent chemotherapy. Neurooncology 3:29–34

    CAS  Google Scholar 

  41. Ang C, Hauerstock D, Guiot MC, Kasymjanova G, Roberge D, Kavan P, Muanza T (2008) Characteristics and outcomes of medulloblastoma in adults. Pediatr Blood Cancer 51(5):603–607

    Article  PubMed  Google Scholar 

  42. Carrie C, Lasset C, Blay JY, Négrier S, Bouffet E, Barbet N, Montbarbon X, Wagner JP, Lapras C, Deruty R et al (1993) Medulloblastoma in adults: survival and prognostic factors. Radiother Oncol 29(3):301–307

    Article  PubMed  CAS  Google Scholar 

  43. Riffaud L, Saikali S, Leray E, Hamlat A, Haegelen C, Vauleon E, Lesimple T (2009) Survival and prognostic factors in a series of adults with medulloblastomas. J Neurosurg 111(3):478–487

    Article  PubMed  Google Scholar 

  44. Germanwala AV, Mai JC, Tomycz ND, Niranjan A, Flickinger JC, Kondziolka D, Lunsford LD (2008) Boost gamma knife surgery during multimodality management of adult medulloblastoma. J Neurosurg 108(2):204–209

    Article  PubMed  Google Scholar 

  45. Ertas G, Ucer AR, Altundag MB, Durmus S, Calikoglu T, Ozbagi K, Abanuz H, Altundag K, Demirkasimoglu A (2008) Medulloblastoma/primitive neuroectodermal tumor in adults: prognostic factors and treatment results: a single-center experience from Turkey. Med Oncol 25(1):69–72

    Article  PubMed  Google Scholar 

  46. Bloom HJ (1977) Medulloblastoma: prognosis and prospect. Int J Radiat Oncol Biol Phys 2:1031–1033

    Article  PubMed  CAS  Google Scholar 

  47. Roldán G, Brasher P, Vecil G et al (2008) Population-based study of medulloblastoma: outcomes in Alberta from 1975 to 1996. Can J Neurol Sci 35:210–215

    PubMed  Google Scholar 

  48. Guessous F, Li Y, Abounader R (2008) Signaling pathways in medulloblastoma. J Cell Physiol 217(3):577–583

    Article  PubMed  CAS  Google Scholar 

  49. Entz-Werle N, Carli ED, Ducassou S, Legrain M, Grill J, Dufour C (2008) Medulloblastoma: What is the role of molecular genetics? Expert Rev Anticancer Ther 8(7):1169–1181

    Article  PubMed  CAS  Google Scholar 

  50. Rossi A, Caracciolo V, Russo G, Reiss K, Giordano A (2008) Medulloblastoma: from molecular pathology to therapy. Clin Cancer Res 14(4):971–976

    Article  PubMed  CAS  Google Scholar 

  51. Bloom HJG, Bessell EM (1990) Medulloblastoma in adults: a review of 47 patients treated between 1952 and 1981. Int J Radiat Oncol Biol Phys 18:763–772

    Article  PubMed  CAS  Google Scholar 

  52. Stupp R, Mason WP, van den Bent MJ, Weller M, Fisher B, Taphoorn MJ, Belanger K, Brandes AA, Marosi C, Bogdahn U, Curschmann J, Janzer RC, Ludwin SK, Gorlia T, Allgeier A, Lacombe D, Cairncross JG, Eisenhauer E, Mirimanoff RO, European Organisation for Research, Treatment of Cancer Brain Tumor, Radiotherapy Groups; National Cancer Institute of Canada Clinical Trials Group (2005) Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 352(10):987–996

    Article  PubMed  CAS  Google Scholar 

  53. Durando X, Thivat E, Gilliot O, Irthum B, Verrelle P, Vincent C, Bay JO (2007) Temozolomide treatment of an adult with a relapsing medulloblastoma. Cancer Invest 25(6):470–475

    Article  PubMed  CAS  Google Scholar 

  54. Mascarin M, Dall’Oglio S, Palazzi M, Sartor G, Marradi PL, Romano M, Maluta S (2010) A case of relapsed medulloblastoma treated with intensity-modulated radiotherapy and temozolomide. Tumori 96(2):327–331

    PubMed  Google Scholar 

  55. Poelen J, Bernsen HJ, Prick MJ (2007) Metastatic medulloblastoma in an adult; treatment with temozolomide. Acta Neurol Belg 107(2):51–54

    PubMed  CAS  Google Scholar 

  56. Nicholson HS, Kretschmar CS, Krailo M, Bernstein M, Kadota R, Fort D, Friedman H, Harris MB, Tedeschi-Blok N, Mazewski C, Sato J, Reaman GH (2007) Phase 2 study of temozolomide in children and adolescents with recurrent central nervous system tumors: a report from the Children’s Oncology Group. Cancer 110(7):1542–1550

    Article  PubMed  CAS  Google Scholar 

  57. Sterba J, Pavelka Z, Andre N, Ventruba J, Skotakova J, Bajciova V, Bronisova D, Dubska L, Valik D (2010) Second complete remission of relapsed medulloblastoma induced by metronomic chemotherapy. Pediatr Blood Cancer 54(4):616–617

    PubMed  Google Scholar 

  58. Nicolson RI, Fawcett AJ (2011) Dislexia, dysgraphia, procedural learning and the cerebellum. Cortex 47(1):117–127

    Article  PubMed  Google Scholar 

  59. Valera EM, Spencer RM, Zeffiro TA, Makris N, Spencer TJ, Faraone SV, Biederman J, Seidman LJ (2010) Neural substrates of impaired sensorimotor timing in adult attention-deficit/hyperactivity disorder. Biol Psychiatry 68:359–367

    Article  PubMed  Google Scholar 

  60. Frange P, Alapetite C, Gaboriaud G, Bours D, Zucker JM, Zerah M, Brisse H, Chevignard M, Mosseri V, Bouffet E, Doz F (2009) From childhood to adulthood: long-term outcome of medulloblastoma patients The Institut Curie experience (1980–2000). J Neurooncol 95(2):271–279 Epub 2009 Jun 12

    Article  PubMed  CAS  Google Scholar 

  61. Haberer S, Assouline A, Mazeron JJ (2010) Normal tissue tolerance to external beam radiation therapy: brain and hypophysis. Cancer Radiother 14(4–5):263–268 French

    Article  PubMed  CAS  Google Scholar 

  62. Habrand JL, Drouet F (2010) Normal tissue tolerance to external beam radiation therapy: spinal cord. Cancer Radiother 14(4–5):269–276

    Article  PubMed  Google Scholar 

  63. Amelio D, Lorentini S, Schwarz M, Amichetti M (2010) Intensity-modulated radiation therapy in newly diagnosed glioblastoma: a systematic review on clinical and technical issues. Radiother Oncol Radiother Oncol 97(3):361–369

    Google Scholar 

  64. Wagner D, Christiansen H, Wolff H, Vorwerk H (2009) Radiotherapy of malignant gliomas: comparison of volumetric single arc technique (RapidArc), dynamic intensity-modulated technique and 3D conformal technique. Radiother Oncol 93(3):593–596

    Article  PubMed  Google Scholar 

  65. Combs SE, Hartmann C, Nikoghosyan A, Jäkel O, Karger CP, Haberer T, von Deimling A, Münter MW, Huber PE, Debus J, Schulz-Ertner D (2010) Carbon ion radiation therapy for high-risk meningiomas. Radiother Oncol 95(1):54–59

    Article  PubMed  CAS  Google Scholar 

  66. Grosu AL, Weber WA (2010) PET for radiation treatment planning of brain tumours. Radiother Oncol 96(3):325–327

    Article  PubMed  Google Scholar 

  67. Leseur J, Carrie C, Le Prisé E, Bernier V, Beneyton V, Mahé MA, Supiot S (2009) Intensity-modulated radiotherapy for cancers in childhood. Cancer Radiother 13(6–7):536–542

    Article  PubMed  CAS  Google Scholar 

  68. Paulino AC, Mazloom A, Teh BS, South M, Okcu MF, Su J, Butler EB, Chintagumpala M (2011) Local control after craniospinal irradiation, intensity-modulated radiotherapy boost, and chemotherapy in childhood medulloblastoma. Cancer 117(3):635–641

    Article  PubMed  Google Scholar 

  69. Sharma DS, Gupta T, Jalali R, Master Z, Phurailatpam RD, Sarin R (2009) High-precision radiotherapy for craniospinal irradiation: evaluation of three-dimensional conformal radiotherapy, intensity-modulated radiation therapy and helical TomoTherapy. Br J Radiol 82(984):1000–1009

    Article  PubMed  CAS  Google Scholar 

  70. Fossati P, Ricardi U, Orecchia R (2009) Pediatric medulloblastoma: toxicity of current treatment and potential role of protontherapy. Cancer Treat Rev 35(1):79–96 Review

    Article  PubMed  CAS  Google Scholar 

  71. Jain N, Krull KR, Brouwers P, Chintagumpala MM, Woo SY (2008) Neuropsychological outcome following intensity-modulated radiation therapy for pediatric medulloblastoma. Pediatr Blood Cancer 51(2):275–279

    Article  PubMed  Google Scholar 

  72. Seppälä J, Kulmala J, Lindholm P, Minn H (2010) A method to improve target dose homogeneity of craniospinal irradiation using dynamic split field IMRT. Radiother Oncol 96(2):209–215

    Article  PubMed  Google Scholar 

  73. Paulino AC, Lobo M, Teh BS, Okcu MF, South M, Butler EB, Su J, Chintagumpala M (2010) Ototoxicity after intensity-modulated radiation therapy and cisplatin-based chemotherapy in children with medulloblastoma. Int J Radiat Oncol Biol Phys 78(5):1445–1450

    Article  PubMed  CAS  Google Scholar 

  74. Muscal JA, Jones JY, Paulino AC, Bertuch AA, Su J, Woo SY, Mahoney DH Jr, Chintagumpala M (2009) Changes mimicking new leptomeningeal disease after intensity-modulated radiotherapy for medulloblastoma. Int J Radiat Oncol Biol Phys 73(1):214–221

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

The authors have no conflict of interest to declare.

Author information

Authors and Affiliations

  1. Bio-Images and Radiological Sciences Department, Radiotherapy Institute, Catholic University of Rome, 00168, Rome, Italy

    M. Balducci, S. Chiesa, S. Manfrida, N. Dinapoli, A. Fiorentino, F. Miccichè, V. Frascino & V. Valentini

  2. Neurosurgery Institute, Catholic University of Rome, 00168, Rome, Italy

    D. Chieffo & C. Anile

  3. AO Spedali Civili, Istituto del Radio “O. Alberti”, Università degli Studi di Brescia, Piazzale Spedali Civili, 1, 25123, Brescia, Italy

    B. De Bari

Authors
  1. M. Balducci
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Chiesa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Chieffo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Manfrida
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. N. Dinapoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A. Fiorentino
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. Miccichè
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. V. Frascino
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. Anile
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. V. Valentini
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. B. De Bari
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. De Bari.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s11060-011-0708-0

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balducci, M., Chiesa, S., Chieffo, D. et al. The role of radiotherapy in adult medulloblastoma: long-term single-institution experience and a review of the literature. J Neurooncol 106, 315–323 (2012). https://doi.org/10.1007/s11060-011-0665-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-011-0665-7

Keywords

Search

Navigation