Medulloblastomas in adolescents and adults – Can the pediatric experience be extrapolated?

Autor: Frappaz, D.; Faure-Conter, C.; Bonneville Levard, A.; Barritault, M.; Meyronet, D.; Sunyach, M.-P.

Publication year: 2021

Neuro-Chirurgie

issn:1773-0619 0028-3770

doi: 10.1016/j.neuchi.2018.10.007

Abstract:

Adult medulloblastomas are orphan diseases that differ from their pediatric counterpart. Most are classified as classic or desmoplastic and fall in the SHH subgroup, mainly with loss-of-function mutations in PTCH1 and some by TP53-mutation due to underlying germline mutation. Activation of the WNT pathway is sporadic, although underlying Turcot syndrome may be present. One-third of tumors are issued from group 4. Most adult studies are small non-randomized retrospective heterogeneous studies performed at a single center with short follow-up. Standard craniospinal irradiation followed by maintenance chemotherapy (CCNU, cisplatin-vincristine) results in a 4-year event-free survival (EFS) and overall survival (OS) of 68% and 89% respectively in standard-risk adults, and in a 4-year EFS and OS of 50% and 90%, respectively in high-risk adults. Several pooled analyses point out the potential role of chemotherapy in adults. The feasibility of pediatric protocols in adults is sometimes hampered because of blood and peripheral nerve toxicity. In the near future, subgroups of medulloblastomas may be treated by personalized therapies. With prolonged follow-up, adults fare worse. Long-term sequelae and second line treatment are not well defined in adults. Prospective studies are ongoing to define optimal first-line and relapse treatments.

Language: eng

Pmid: 30554773

Tags: Humans; Female; Male; Prospective Studies; Adult; Retrospective Studies; Child; Adolescent; Young Adult; Child, Preschool; chemotherapy; Antineoplastic Combined Chemotherapy Protocols/therapeutic use; Vincristine/therapeutic use; Medulloblastoma; Adults; Progression-Free Survival; Surgery; Adolescents; Cerebellar Neoplasms/*diagnosis/*genetics/therapy; Cisplatin/therapeutic use; Craniospinal irradiation; Medulloblastoma/*diagnosis/*genetics/therapy; Mutation/physiology; Neurosurgical Procedures/methods/trends; Personalized medicine; Radiotherapy/methods/trends

Link: https://pubmed.ncbi.nlm.nih.gov/30554773/