NO SALVAGE USING HIGH-DOSE CHEMOTHERAPY PLUS/MINUS REIRRADIATION FOR RELAPSING PREVIOUSLY IRRADIATED MEDULLOBLASTOMA

作者：Massimino Maura^*; Gandola Lorenza; Spreafico Filippo; Biassoni Veronica; Luksch Roberto; Collini Paolo; Solero Carlo N; Simonetti Fabio; Pignoli Emanuele; Cefalo Graziella; Poggi Geraldinia; Modena Piergiorgio; Mariani Luigi; Potepan Paolo; Podda Marta; Casanova Michele; Pecori Emilia; Acerno Stefania; Ferrari Andrea; Terenziani Monica; Meazza Cristina; Polastri Daniela; Ravagnani Fernando; Fossati Bellani Franca

来源：International Journal of Radiation Oncology, Biology, Physics, 2009, 73(5): 1358-1363.

DOI：10.1016/j.ijrobp.2008.06.1930

• Medulloblastoma
• Relapse
• Myeloablative Chemotherapy
• Reirradiation

Purpose: Myeloablative regimens were frequently used for medulloblastoma relapsing after craniospinal irradiation (CSI): in 1997-2002, we used repeated surgery, standard-dose and myeloablative chemotherapy, and reirradiation.
Methods and Materials: In 10 patients, reinduction included sequential high-dose etoposide, high-dose cyclophosphamide/vincristine, and high-dose carboplatin/vincristine, then two myeloablative courses with high-dose thiotepa ( /- carboplatin); 6 other patients received two of four courses of cisplatin/etoposide. Hematopoietic precursor mobilization followed high-dose etoposide or high-dose cyclophosphamide or cisplatin/etoposide therapy. After the overall chemotherapy program, reirradiation was prescribed when possible.
Results: Seventeen patients were treated: previous treatment included CSI of 19.5-36 Gy with posterior fossa/tumor boost and chemotherapy in 16 patients. Fifteen patients were in their first and 2 in their second and third relapses, respectively. First progression-free survival had lasted a median of 26 months. Relapse sites included leptomeninges in 9 patients, spine in 4 patients, posterior fossa in 3 patients, and brain in 1 patient. Three patients underwent complete resection of recurrence, and 10 underwent reirradiation. Twelve of 14 patients with assessable tumor had an objective response after reinduction; 2 experienced progression and were not given the myeloablative courses. Remission lasted a median of 16 months. Additional relapses appeared in 13 patients continuing the treatment. Fifteen patients died of progression and 1 died of pneumonia 13 months after relapse. The only survivor at 93 months had a single spinal metastasis that was excised and irradiated. Survival for the series as a whole was 11-93 months, with a median of 41 months.
Conclusions: Despite responses being obtained and ample use of surgery and reirradiation, second-line therapy with myeloablative schedules was not curative, barring a few exceptions. A salvage therapy for medulloblastoma after CSI still needs to be sought.

• 出版日期2009-4-1