Chemotherapy and RT Improve Survival in Surgically Resected Medulloblastoma Patients

Medulloblastoma, a common pediatric ailment, is rare in adults, but the treatment in adult patients reflects the results observed in the younger patient population. While chemotherapy has largely been used in adults to treat this type of brain tumor, the outcomes are not very clear. A new study presented at the annual meeting of the American Society for Radiation Oncology (ASTRO) has found a significant survival advantage of combining chemotherapy and radiotherapy following surgery in patients with medulloblastoma.

The authors at Yale Cancer Center analyzed data from the National Cancer Data Base on 751 adult patients diagnosed with medulloblastoma, who had surgical resection and post-surgical radiation. Five-hundred and twenty (69.2%) of these patients were treated with both chemotherapy and radiation therapy, while the remaining 231 (30.8%) patients only received radiation. The 5-year overall survival (OS) was 86.1% in the first group and 71.6% in the second group—a 14.5% improvement with the inclusion of chemotherapy.

“Our analysis is the first to clearly demonstrate the improved survival that chemotherapy adds post-surgery for adult patients with medulloblastoma,” the study’s first author Benjamin H. Kann, MD, said in a statement. “We can now confidently support the addition of chemotherapy to radiation therapy for our patients who can tolerate both treatments.”

A previous study by the authors, published in the August issue of JAMA Oncology, evaluated the effect of chemotherapy alone as adjuvant treatment post surgery in children 3 to 8 years of age who had developed a medulloblastoma. This retrospective analysis of information mined from the National Cancer Data Base analyzed the impact of postoperative radiotherapy deferral in these children.

Of the 816 cases of children who underwent surgery and received adjuvant chemotherapy between 2004 and 2012, a little over 15% did not receive postoperative radiotherapy or saw a 90-day delay in receiving radiation following surgery (deferred group). A significant correlation was observed between deferral and the child’s age—older patients were less likely to defer radiotherapy. Also, deferral rates increased over the study period, from 8.1% (2005) to 27.1% (2012).

The 5-year OS was 63.4% among children in whom radiation was deferred, compared with 82% in children who received radiotherapy upfront post surgery. The authors also observed that deferral of post-operative radiotherapy was a significant predictor of worse OS, with a hazard ratio of 1.95.

Considering the findings of both analyses, the combination of chemotherapy and radiation therapy following surgical resection in patients with medulloblastoma seems ideal for improved 5-year survival.