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Journal of Neurosurgical Sciences 2021 Nov 11

DOI: 10.23736/S0390-5616.21.05548-X

Copyright © 2021 EDIZIONI MINERVA MEDICA

lingua: Inglese

Medulloblastoma in adults: an analysis of clinico-pathological, molecular and treatment factors

Federica FRANCHINO 1 , Isabella MORRA 2, Marco FORNI 3, Luca BERTERO 2, Cristina ZANINI 4, Fausto ROVETA 1, Umberto RICARDI 5, Cristina MANTOVANI 5, Allegra CARPANETO 1, Enrica MIGLIORE 6, Alessia PELLERINO 1, Federica FERRIO 7, Paola CASSONI 2, Diego GARBOSSA 8, Riccardo SOFFIETTI 1, Roberta RUDA’ 1, 9

1 Department of Neuro-Oncology, University and City of Health and Science Hospital, Turin, Italy; 2 Pathology Unit, Department of Medical Sciences, University and City of Health and Science Hospital, Turin, Italy; 3 Molecular Biotechnology Center, University of Turin, Turin, Italy; 4 Scientific Department, BioAir Spa, Molecular Biotechnology Center, University of Turin, Turin, Italy; 5 Department of Radiotherapy, University and City of Health and Science Hospital, Turin, Italy; 6 Unit of Cancer Epidemiology (CPO Piemonte), University of Turin, Turin, Italy; 7 Department of Neuroradiology, University and City of Health and Science Hospital, Turin, Italy; 8 Department of Neurosurgery, University and City of Health and Science Hospital, Turin, Italy; 9 Department of Neurology, Castelfranco Veneto, Treviso, Italy


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BACKGROUND: Medulloblastoma is a highly malignant, embryonal tumor, which is rare in adults, and shows distinct clinical, histopathological, molecular and treatment response features.
METHODS: We retrospectively investigated 44 adults (age 17-48 years) with an histological diagnosis of medulloblastoma, and in 23 immunohistochemistry was used to identif y the molecular subgroups. We analyzed demographic, diagnostic, therapeutic and cognitive data, and correlated with PFS (progression-free-survival) and OS (overall survival).
RESULTS: We observed a male prevalence and a median age of 31 years. Symptoms at onset were related to infratentorial location, while myeloradicular and/or cranial nerve involvement was rare. Histological examination showed the classic variant in 75% of patients, the desmoplastic/nodular in 23% and the anaplastic in one. As for molecular diagnosis, 17 patients were SHH and 6 non-WNT/non-SHH (5 group 4 and 1 group 3), while no WNT subgroup was found. The SHH subgroup had a prevalence of high-risk patients and leptomeningeal involvement. Patients underwent grosstotal or subtotal/partial resection, and craniospinal irradiation, followed in 20 cases by adjuvant chemotherapy. Median OS and PFS were 16.9 and 12 years, respectively. Metastatic disease at presentation and subtotal/partial resection were associated with worse prognosis, while the addition of chemotherapy did not yield a significant advantage over radiotherapy alone. Cognitive impairment in long-term survivors was limited and late relapses occurred in 15% of patients.
CONCLUSIONS: Future studies with adequate sample size and long-term follow-up should prospectively investigate the role of surgery and adjuvant therapies across the different molecular subgroups to see whether a personalized approach is feasible.


KEY WORDS: Medulloblastoma; Adults; Chemotherapy; Radiotherapy; Surgery; Molecular subgroup

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