Survival of patients with medulloblastoma treated with carboplatin and etoposide before and after radiotherapy.

BACKGROUND: Medulloblastoma represents 20% of all tumors of the central nervous system. Patients with partial resection of the tumor and those with extension into the neuraxis at diagnosis have been identified as high-risk patients. The objective of our study was to determine tumor response, survival rates and toxicity with a new scheme of treatment with carboplatin, etoposide and radiotherapy. METHODS: All patients received chemotherapy with carboplatin and etoposide every 4 weeks for four courses, hyperfractionated radiotherapy, and another four courses of the above chemotherapy scheme. Tumor response was classified, and global and disease-free survival rates were calculated according to the actuarial survival method. RESULTS: A total of 26 patients were included, with a median age of 6.9 years. Nineteen achieved complete response after the first four courses of chemotherapy, and two more had a complete response after radiotherapy. A total of seven children have died, three of whom did not respond to initial treatment. Global and disease-free survival rates were 69% and 64%, respectively, at 60 months of follow-up. There was no renal or auditory toxicity. Hematological toxicity was transitory and reversible. CONCLUSIONS: This scheme of treatment is effective and can be safely used for pediatric patients with high-risk medulloblastomas. Toxicity was not significant, and survival is similar to other reports.

[Parinaud's syndrome in children]. / Síndrome de Parinaud en niños.

OBJECTIVE: To describe the clinical and ethiologic findings of children with Parinaud's syndrome. MATERIAL AND METHODS: 11 children fulfilling the clinical criteria for Parinaud's syndrome were studied. The mean age was 10 years with a range of 10 months to 14 years. RESULTS: Seven cases were tumors (pineal germinoma in four and one each with teratoma, astrocytoma, and an undefined tumor); the remaining 4 cases corresponded to arachnoid cyst in the III ventricule, cysticercosis, tuberculoma and multiple sclerosis. The main treatment was surgical including ventriculoperitoneal shunt because of hydrocephalous secondary to mechanical obstruction. Chemotherapy and radiotherapy were also used for the tumor cases, and steroids for the multiple sclerosis patient. CONCLUSIONS: In contrast to adults, Parinaud's syndrome in our children was associated with a mass, mainly tumoral, which interrupted the afferent and efferent connections of the midbrain structures, such as posterior commissure, riMLF or the interstitial nucleus of Cajal.

[Astrocytomas in pediatrics. The prognostic factors and survival]. / Astrocitomas en pediatría. Factores pronósticos y sobrevida.

Tumors of the central nervous system are the second most frequent malignancy in children under the age of 15 the majority of which are astrocytomas. The purpose of this paper is to analyze the effect of some factors on the survival of patients with astrocytomas. We reviewed the clinical charts of patients with a diagnosis of astrocytoma from 1984 to 1995 and we analyzed the age, sex, location, malignant grade and survival according to the actuarial method and log rank tests. A total of 39 patients were detected, 43% were supratentorial, 13% cerebellar and 43% from the brain stem. There was a better prognosis for those located supratentorial or cerebellar with respect to those in the brain stem, with statistical significance. The treatment consisted in surgical resection in 26 patients, 17 of which were found to have a high grade of malignancy and 9 with low grade, with statistically better prognosis for low grade tumors. There were 17 deaths during the period, with 8 of these patients having a high grade tumor a 10, with brain stem tumors. Forty-one percent of the patients that died did so in the first year and 94% during the first two years after diagnosis. Patients with cerebellar astrocytoma and patients with low-grade astrocytomas had the best prognosis.