초록 열기/닫기 버튼
Purpose The purpose of this study is to investigate the long-term results and appropriateness ofradiation therapy (RT) for medulloblastoma (MB) at a single institution. Materials and MethodsWe analyzed the clinical outcomes of 106 patients with MB who received RT betweenJanuary 1992 and October 2009. The median age was 7 years (range, 0 to 50 years), andthe proportion of M0, M1, M2, and M3 stages was 60.4%, 8.5%, 4.7%, and 22.6%, respectively. The median total craniospinal irradiation (CSI) and posterior fossa tumor bed dose in102 patients (96.2%) treated with CSI was 36 Gy and 54 Gy, respectively. ResultsThe median follow-up period in survivors was 132 months (range, 31 to 248 months). Agradual improvement in survival outcomes was observed, with 5-year overall survival ratesof 61.5% in 1990s increasing to 73.6% in 2000s. A total of 29 recurrences (27.4%) developedat the following sites: five (17.2%) in the tumor bed; five (17.2%) in the posterior fossaother than the tumor bed; nine (31%) in the supratentorium; and six (20.7%) in the spinalsubarachnoid space only. The four remaining patients showed multiple site recurrences. Among 12 supratentorial recurrences, five cases recurred in the subfrontal areas. Althoughthe frequency of posterior fossa/tumor bed recurrences was significantly high amongpatients treated with subtotal resection, other site (other intracranial/spinal) recurrenceswere more common among patients treated with gross tumor removal (p=0.016). Therewas no case of spinal subarachnoid space relapse from desmoplastic/extensive nodularhistological subtypes. ConclusionLong-term follow-up results and patterns of failure confirmed the importance of optimal RTdose and field arrangement. More tailored multimodal strategies and proper CSI techniquemay be the cornerstones for improving treatment outcomes in MB patients.
