Radiotherapy and adjuvant chemotherapy for childhood medulloblastoma. The Royal Marsden Hospital experience.

PURPOSE: We reviewed the outcome of children with medulloblastoma treated from 1970 to 1985 with combined radiotherapy and chemotherapy. PATIENTS AND METHODS: Fifty-seven children with a median age of 8 years (range 1 to 16 years) at diagnosis were analyzed regarding survival, site and time of recurrence, treatment toxicity, prognostic factors and performance status. RESULTS: The overall 5- and 10-year-survival was 66% and 54%, respectively. Patients with subarachnoid metastases or positive cerebrospinal fluid cytology (M1-3) had a shorter survival compared with those without it (p < 0.1). Furthermore, survival appeared to improve with the addition of lomustine (CCNU) to vincristine chemotherapy with a 5-year-survival of 70% versus 31% (relative risk 3.4, 95% confidence interval 1.4 to 8.1) although it should be noted that these were consecutive not randomized patients treated. Of the 52 patients achieving remission, 17 relapsed either in primary (2), spine (5) or a combination of these (10). Two patients developed bone metastases without central nervous system recurrence. Performance status measured crudely appeared to be good in long-term survivors. Of 31 patients that survived for long-term follow-up and had their performance evaluated, 28 had no or minor residual neurological signs and the remaining 3 were disabled. CONCLUSION: Combined modality treatment for medulloblastoma in childhood was able to cure 54% of patients with a good performance status in the majority of survivors.