Combined Therapy of Medulloblastoma: Review of 46 Patients Treated in a Single Institution

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Abstract
Medulloblastoma is the most frequent malignant brain tumor in pediatric patients. Early treatment strategies, combining surgery and radiotherapy alone, resulted in survival rates of about 40% only. In the last 15 years, chemotherapy was used more frequently in combination with surgery and radiotherapy. The rationale was to increase the survival rate and to decrease radiation toxicity in young children. Forty-six patients younger than 16 years were treated between July 1977 and September 1995 in our institution (32 boys and 14 girls). Thirty-nine patients could be evaluated according to their postoperative treatment with regard to different protocols such as SIOP 1, SIOP 2, HDMTX/VCR, HIT protocol 89/91 and Carbo-PEI (one patient). In total, 21/39 patients are alive without evidence of disease (EFS 55 +/- 7%) with a follow-up of 26 to 210 months. Four children are lost to follow-up. Twelve patients died after relapse, 1 child died of MTX-induced brain atrophy, 1 patient developed a secondary malignancy (acute lymphoblastic leukemia) and died. The best results were seen in patients treated according to the HIT 89/91 protocol as first-line treatment (CR 9/10). The improvement in outcome of our patients with medulloblastoma in recent years suggests the benefit of intensified chemotherapy on survival. In addition, refinement in surgical and radiological treatment have certainly also contributed to the better results.

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