Summary
Although recently survival of some medulloblastoma patients increased remarcably, it remains a serious diagnosis in others. In order to predict the postoperative prognosis in patients treated for medulloblastoma, a new staging, scoring and grading system was developed.
Sixty-six patients operated on microsurgically between 1975 and 1990 at a single neurosurgical center were fully followed-up. No patient was excluded due to a poor postoperative course. Completion of commonly used radiotherapy protocols was attempted in all patients. Survival of patients was evaluated by the Kaplan-Meier method.
The following 5 parameters were selected to define subgroups: patients' age, tumour location and histology, degree of resection and presence or absence of metastases. Patients older than 10 years had a better prognosis than individuals aged 10 or less (p<0.01), patients with lateral tumours had a better prognosis than patients with midline tumours with brain stem infiltration (p<0.05), patients with complete tumour resection had a more favourable prognosis than individuals with subtotal (p<0.01) or partial resection (p<0.001), patients without metastases at the time of diagnosis had a better prognosis than individuals without such evidence (p<0.001), patients with the desmoplastic tumour variant had a better prognosis than patients with classical tumour histology (p<0.01).
According to the prognosis of a distinct subgroup, scoring points were distributed which correlated with the degree of inter-subgroup significances. The sum of a single patient's scoring points was called the total score. Based on this score, three groups of prognosis were distinguished. The good prognosis group (n=29) showed a significantly better survival (p<0.05) than the moderate prognosis group (n=26), whereas the moderate prognosis group had a significantly better survival (p<0.05) than the poor prognosis group (n=11). A Kaplan-Meier survival rate of 62% was found in patients of the good prognosis group, a rate of 22% in the moderate prognosis group, and a rate of 0% in the poor prognosis group.
It is concluded that this new staging, scoring and grading system is a simple and recommendable prognostic system for all patients treated surgically for medulloblastoma.
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References
Allen JC, Meyers P, Epstein F (1981) Medulloblastoma. Tumor dissemination at diagnosis associated with young age and poor prognosis. Proc Am Assoc Cancer Res 22: 404 (Abstract)
Bailey P, Cushing H (1925) Medulloblastoma cerebelli. A common type of midcerebellar glioma of childhood. Arch Neurol Psych 14: 192–224
Berger EC, Elvidge AR (1963) Medulloblastomas and cerebellar sarcomas. J Neurosurg 20: 139–144
Berger MS, Baumeister B, Geyer JR, Milstein J, Kanev PM, Le Roux PD (1991) The risks of metastases from shunting in children with primary central nervous system tumours. J Neurosurg 74: 872–877
Berghorn WJ (1982) Untersuchungen zur biologischen Wertigkeit des klassischen und des desmoplastischen Medulloblastoms. Dissertation aus der Neurochirurgischen Klinik der Universität Düsseldorf, Düsseldorf, Germany, pp 1–77
Berry MP, Jenkin RD, Keen CW, Nair BD, Simpson WJ (1981) Radiation treatment for medulloblastoma: a 21-year review. J Neurosurg 55: 43–51
Caputy Aj, McCullough DC, Manz HJ, Patterson K, Hammock MK (1987) A review of the factors influencing the prognosis of medulloblastoma. J Neurosurg 66: 80–87
Carrie C, Bouffet E, Brunat-Mentigny M, Philip T, Lacroze M (1989) Les tumeurs cerebrales primitives de l'enfant partie II: Etude topographique et traitment. Bull Cancer 76: 255–272
Chang CH, Housepian EM, Herbert C (1969) An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas. Radiology 93: 1351–1359
Chatty EM, Earle KM (1971) Medulloblastoma: a report of 201 cases with emphasis of the relationship of histological variants to survival. Cancer 28: 977–983
Chin HW, Maruyama Y (1981) Proposed clinical staging system for medulloblastoma. Int J Radiat Oncol Biol Phsy 7: 1285 (Abstract)
Chin HW, Maruyama Y (1984) The CT assisted staging system for medulloblastoma. 3rd Annual Meeting of the European Society for therapeutic Radiology and Oncology, September 9–15, Jerusalem, Israel, p 297
Choux M (1982) Medulloblastoma in children. Childs Brain 9: 280–283
Choux M, Lena G (1983) Le medulloblastome. Neurochirurgie 28 [Suppl 1]: 229 p
Cornu P, Chattellier G, Fauchon F, Foncin JF, Faillot T, Dorwling-Carter D, Philippon J (1990) Pronostic des medulloblastomes de l'adulte. Neurochirurgie 36: 218–224
Deutsch M, Reigel DH (1980) The value of myelography in the management of childhood medulloblastoma. Cancer 45: 2194–2197
Deutsch M (1988) Medulloblastoma: staging and treatment outcome. Int J Rad Oncol Biol Phys 14: 1103–1107
Dexter D, Howell DA (1965) Medulloblastomas and arachnoidal sarcomas. Brain 88: 367–374
Evans AE, Jenkin DT, Sposto R, Ortega JA, Wilson CB, Wara W, Ertel IJ, Kramer S, Chang CH, Leikin S, Hammond GD (1990) The treatment of medulloblastoma. Results of a prospective randomized trial of radiation therapy with and without CCNU, vincristine and prednisone. J Neurosurg 72: 572–582
Gartton GA, Schomberg PJ, Scheitauer BW, Shaw EJ, Ilstrup DM, Blackwell CA, Laws ER, Earle JD (1990) Medulloblastoma — prognostic factors and outcome of treatment: Review of the Mayo Clinic experience. Mayo Clin Proc 65: 1077–1086
Geyer R, Levy M, Berger MS, Milstein J, Griffin B, Bleyer WA (1991) Infants with medulloblastomas: a single institution review of survival. Neurosurgery 29: 707–711
Hart MN, Earle KM (1973) Primitive neuroectodermal tumors of the brain in children. Cancer 32: 890–897
Inoue I, Yoshida J, Kageyama N (1985) Analysis of various factors related to the prognosis of medulloblastoma. No Shinkei Geika 13: 1283–1289 (in Japanese)
Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53: 457–481
Kopelson G, Linggood RM, Kleinmann GM (1983) Medulloblastoma. The identification of prognostic subgroups and implications for multimodality management. Cancer 51: 312–319
Laurent JP, Chang CH, Cohen ME (1985) A classification system for primitive neuroectodermal tumors (medulloblastomas) of the posterior fossa. Cancer 56: 1807–1809
Packer RJ, Sutton LN, Rorke LB, Littman PA, Sposto R, Rosenstock JG, Bruce DA, Schut L (1984) Prognostic importance of cerebellar differentiation in medulloblastoma of childhood. J Neurosurg 61; 296–301
Park TS, Hoffman HJ, Hendrick EB, Humphreys RP, Laurence LE (1983) Medulloblastoma: clinical presentation and management. J Neurosurg 58: 543–552
Rorke LB (1983) The cerebellar medulloblastoma and its relationship to primitive neuroectodermal tumors. J Neuropathol Exp Neurol 42: 1–15
Rubinstein LJ, Northfield DW (1964) The medulloblastoma and the so called “arachnoidal cerebellar sarcoma”. Brain 87: 379–412
San Galli F, Maire JP, Guerin J (1991) Medulloblastome: vers de nouveaux facteurs pronostiques. Neurochirurgie 37: 3–11
Schofield DE, Yunis EJ, Geyer R; Albright AL, Berger MS, Taylor SR (1991) DNA content and other prognostic features in childhood medulloblastoma. Proposal of a scoring system. Cancer 69: 1307–1314
Seeger W (1980) Microsurgery of the brain, Vol II. Springer, Wien New York
Seeger W (1986) Planning strategies of intracranial microsurgery. Springer, Wien New York
Stanley P, Suminski N (1988) The incidence and distribution of spinal metastases in children with posterior fossa medulloblastoma. Am J Pediatr Hematol Oncol 10: 283–287
Stiller CA, Bunch KJ (1990) Trends in survival of childhood cancer in Britain diagnosed 1971–1985. Br J Cancer 62: 806–815
Sure U (1993) Untersuchungen zum Medulloblastom. Inauguraldissertation der Medizinischen Fakultät der Universität Freiburg, Freiburg, Germany, pp 1–145
Taomoto K, Tomita T, Raimondi AJ, Leestma JE (1987) Medulloblastomas in childhood: histological factors influencing patients' outcome. Childs Nerv Syst 3: 354–360
Tomita T, McLone DG (1983) Spontaneous seeding of medulloblastoma: results of cerebrospinal fluid cytology and arachnoid biopsy from the cisterna magna. Neurosurgery 12: 265–267
Watt TJ, Winfield JA (1987) Analyzing factors influencing medulloblastoma prognosis. J Neurosurg 67: 471–472
Woo SY, McCullough D, Sinks LF (1984) Primary therapy of medulloblastoma with surgery, radiation and adjuvant methotrexate and BCNU — a pilot study. J Neurooncol 2: 288 (Abstract)
Yasue M, Tomita T, Engelhard H, Gonzalez-Crussi F, McLone DG, Bauer KD (1989) Prognostic importance of DNA ploidity in medulloblastoma of childhood. J Neurosurg 70: 385–391
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Sure, U., Berghorn, W.J., Bertalanffy, H. et al. Staging, scoring and grading of medulloblastoma. Acta neurochir 132, 59–65 (1995). https://doi.org/10.1007/BF01404849
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DOI: https://doi.org/10.1007/BF01404849