Relapse in medulloblastoma: what can be done after abandoning high-dose chemotherapy? A mono-institutional experience.

Abstract

PURPOSE:

We retrospectively report strategies used for medulloblastoma patients progressing after craniospinal irradiation where we aimed for: symptom control, a satisfactory quality of life, accrual in phase 1-2 trials, when available, and the first two conditions could no longer be satisfied by already experienced second-line strategies.

METHODS:

Surgery was used in cases of doubtful relapse or when only one site was affected. Radiotherapy was given whenever possible, especially to relieve symptoms. The main chemotherapy regimens were oral temozolomide/etoposide, intravenous (iv.) cisplatin/etoposide, iv. gemcitabine/oxaliplatin, an oral sonic hedgehog pathway inhibitor and oral melphalan.

RESULTS:

Between 1998 and 2011, we treated 18 patients relapsed after median 20 months. Nine had relapsed locally, four had dissemination, three single metastases, and two had one synchronous local and metastatic recurrence. Responses to chemotherapy were seen in 32% of cases. The median hospital stay for treatments/complications was 19 days. The 1- and 3-year progression-free survival (PFS) rates were 28 ± 10% and 0%, respectively, for OS, they were 44 ± 12% and 22 ± 10% but no patient was cured. The median PFS after a first relapse was 7 months (range 1-29); the median OS was 7 months (range 4-44). No patients died due to treatment toxicity. Late recurrence (more than 1-2 years after diagnosis) and involvement of single sites were favorable prognostic factors.

CONCLUSIONS:

Without succeeding in patients cure, we ensured them further treatment with short hospital stay thus affording low personal and social costs. The chances of cure may emerge from tailored therapies according to genetic stratification.

• Authors: Maura Massimino, Michela Casanova, Daniela Polastri, Veronica Biassoni, Piergiorgio Modena, Emilia Pecori, Elisabetta Schiavello, Marco Vajna De Pava, Alice Indini, Paolo Rampini, Dario Bauer, Serena Catania, Marta Podda, Lorenza Gandola
• Journal: Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery (Childs Nerv Syst) Vol. 29 Issue 7 Pg. 1107-12 (Jul 2013) ISSN: 1433-0350 [Electronic] Germany
• PMID: 23595805 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Organoplatinum Compounds
• Oxaliplatin
• Deoxycytidine
• Etoposide
• Irinotecan
• Dacarbazine
• Cisplatin
• Melphalan
• Camptothecin
• Temozolomide
• Gemcitabine

Topics

• Administration, Intravenous
• Administration, Oral
• Adolescent
• Adult
• Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
• Brain Neoplasms (therapy)
• Camptothecin (administration & dosage, analogs & derivatives)
• Cerebellar Neoplasms (therapy)
• Child
• Child, Preschool
• Cisplatin (administration & dosage)
• Clinical Trials, Phase I as Topic
• Clinical Trials, Phase II as Topic
• Cranial Irradiation (methods)
• Dacarbazine (administration & dosage, analogs & derivatives)
• Deoxycytidine (administration & dosage, analogs & derivatives)
• Disease Progression
• Disease-Free Survival
• Etoposide (administration & dosage)
• Female
• Humans
• Irinotecan
• Male
• Medulloblastoma (therapy)
• Melphalan (administration & dosage)
• Neoplasm Recurrence, Local (therapy)
• Organoplatinum Compounds (administration & dosage)
• Oxaliplatin
• Patient Selection
• Quality of Life
• Radiotherapy (methods)
• Retrospective Studies
• Salvage Therapy
• Temozolomide
• Young Adult
• Gemcitabine