Distinctive clinical course and pattern of relapse in adolescents with medulloblastoma

Tabori, Uri; Sung, Lillian; Hukin, Juliette; Laperriere, Normand; Crooks, Bruce; Carret, Anne-Sophie; Silva, Mariana; Odame, Isaac; Mpofu, Chris; Strother, Douglas; Wilson, Beverly; Samson, Yvan; Bouffet, Eric; Canadian Pediatric Brain Tumor Consortium,

doi:10.1016/j.ijrobp.2005.07.962

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Volume 64, Issue 2 , Pages 402-407, 1 February 2006

Distinctive clinical course and pattern of relapse in adolescents with medulloblastoma

Uri Tabori, M.D.
- Pediatric Brain Tumor Program, The Hospital for Sick Children, Toronto, Ontario, Canada
- Reprint requests to: Uri Tabori, M.D., The Hospital for Sick Children, Department of Pediatric Hematology/Oncology, 555 University Ave., Toronto, ON M5G1X8, Canada. Tel: (416) 813-8206; Fax: (416) 813-8851
Lillian Sung, M.D., Ph.D.
- Department of Hematology/Oncology, The Hospital for Sick Children, Toronto, Ontario, Canada
Juliette Hukin, M.D.
- Department of Neurology-Oncology, British Columbia’s Children’s Hospital, Vancouver, British Columbia, Canada
Normand Laperriere, M.D.
- Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada
Bruce Crooks, M.D.
- Department of Hematology/Oncology, IWK Health Centre, Halifax, Nova Scotia, Canada
Anne-Sophie Carret, M.D.
- Department of Hematology/Oncology, Montreal Children’s Hospital, Montreal, Quebec, Canada
Mariana Silva, M.D.
- Department of Hematology/Oncology, Kingston General Hospital, Kingston, Ontario, Canada
Isaac Odame, M.D.
- Department of Hematology/Oncology, McMaster University, Hamilton, Ontario, Canada
Chris Mpofu, M.D.
- Department of Hematology/Oncology, Saskatoon Cancer Center, Saskatoon, Saskatchewan, Canada
Douglas Strother, M.D.
- Departments of Oncology and Pediatrics, University of Calgary, Calgary, Alberta, Canada
Beverly Wilson, M.D.
- Department of Hematology/Oncology, Stollery Children’s Hospital, Edmonton, Alberta, Canada
Yvan Samson, M.D.
- Department of Hematology/Oncology, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada
Eric Bouffet, M.D.
- Pediatric Brain Tumor Program, The Hospital for Sick Children, Toronto, Ontario, Canada
Canadian Pediatric Brain Tumor Consortium

Received 4 June 2005; received in revised form 13 July 2005; accepted 16 July 2005. published online 29 September 2005.

Purpose: To report the clinical course of adolescents with medulloblastoma, with specific emphasis on prognosis and pattern of relapse.

Methods and Materials: We retrospectively studied the clinical course and outcomes of children aged 10–20 years with medulloblastoma, treated at centers throughout Canada between 1986 and 2003. To better assess time to relapse, a cohort of patients aged 3–20 years at diagnosis was generated.

Results: A total of 72 adolescents were analyzed. Five-year overall survival and event-free survival rates were 78.3% ± 5.4% and 68.0% ± 6.2%, respectively. Late relapses occurred at a median of 3.0 years (range, 0.3–6.8 years). In univariate analysis, conventional risk stratification and the addition of chemotherapy to craniospinal radiation did not have prognostic significance. Female patients had improved overall survival (p = 0.007). Time to relapse increased with age in a linear fashion. After relapse, patients faired poorly regardless of treatment modality. Patients who did not receive chemotherapy initially had improved progression-free survival at relapse (p = 0.05).

Conclusions: Our study suggests that adolescents with medulloblastoma might have a unique prognosis and pattern of relapse, dissimilar to those in younger children. They might benefit from different risk stratifications and prolonged follow-up. These issues should be addressed in future prospective trials.

Keywords: Medulloblastoma , Adolescence , Prognosis , Relapse