Treatment of high-risk medulloblastoma by three dimensional conformal radiotherapy and intrathecal injection followed by systemic chemotherapy / 中华神经医学杂志

ABSTRACT

Objective To summarize the clinical efficacy of three dimensional conformal radiotherapy with concomitant intrathecal injection followed by systemic chemotherapy in the treatment of high-risk medulloblastoma (MB). Methods The clinical data of 20 patients with high-risk MB,admitted to our hospital from January 2005 to January 2008 and certified postoperatively by pathological examination, were retrospectively analyzed in our study; 15 of them were found tumors in the cerebrospinal fluid and MRI indicated 5 were with nodular cultivation in the spinal cord.Three-dimensional conformal radiation therapy was done for all the patients with the same techniques:28-36 Gy to the whole cranialspinal axis followed by a boost of 18 Gy. All the patients received intrathecal injection with cytarabine and amethopterin concomitantly followed by systemic chemotherapy with nimustine and temozolomide. The treatment efficacy was concluded. Results The mean follow-up was 48.5 months.Three months after treatment,the complete remission (CR) was achieved in 18 (90.0％),and partial remission in 1 (5.0％),and stabilization in 1 (5.0％).Four patients were failed of treatment and died; 1 had recurrence in the region,and 3 had spinal cord planting progress.The median survival time was 53 months; and 3-y overall survival and 3-y disease-free survival were 80.0％ and 75.5％,respectively.The major side effects occurred in hematological system and digestive system.No grade Ⅳ bone marrow suppression was noted. Conclusion Three-dimensional conformal radiotherapy and intrathecal injection followed by systemic chemotherapy for high-risk MB is safe and feasible,enjoying good prognosis.