Medulloblastoma

To elucidate the diagnosis, treatment and prognosis of medulloblastoma in both children and adults.

A retrospective review was conducted in 80 patients with medulloblastoma confirmed pathologically during the period of 1984 and 1995. Multivariate analysis and comparison were made of the therapeutic effects of operation, radiotherapy and chemotherapy as well as the survival period.

There were 42 males and 38 females with average age at diagnosis being 9.1 years in children and 25.1 years in adults. All patients were operated on to remove the tumour. Cerebral aqueduct re-opening was got through in 54 cases (67.5%), and Torkilsen's shunt was carried out at the same time for the rest patients. Seventeen patients had ventriculoperitoneal shunt, and 13 of them were performed after surgical excision of the tumour. Complete follow-up information was obtained in 61 patients (76%) for a period of 6 months to 14 years. During the follow-up, 27 patients received postoperative craniospinal irradiation, and 27 local radiation. Fourteen patients were subjected to adjuvant chemotherapy. The overall 5-year and 10-year survival rates were 50.5% and 27.89% respectively. The 5-year survival rate was higher in adults than in children (P < 0.05), whereas the 10-year survival rate was similar. Thirty-two patients died of relapse or metastasis between 6 months and 10 years after initial surgical therapy, and the mean recurrence time was 3.5 years.

Operation and postoperative regular radiotherapy were important therapeutic modalities for medulloblastoma. Total or subtotal removal of the tumour combined with craniospinal radiotherapy can improve patients' survival rate. The survival period of medulloblastoma patients is consistent with Collins' law, that is, the period of risk for survival is the age at initial diagnosis plus 9 months. Only few patients can gain long-term survival.