Myelography and cytology for staging very young children with medulloblastoma

Children under 5 years of age with medulloblastoma reportedly have a worse prognosis than older patients. Twenty-four patients under 5 years of age who completed radiotherapy are reviewed. Eleven were diagnosed after 1974 and were prospectively staged for dissemination with myelography and cerebral spinal fluid (CSF) cytology. Thirteen patients were treated before 1974 and without prior myelography or cytology studies. Six of 11 staged patients had abnormal myelograms and one additional patient had malignant cells in the CSF. Thus, only 4/11 staged patients were without evidence of dissemination. Seven of the 11 staged patients are alive and well at least 29 months from diagnosis. All four patients without evidence of dissemination at diagnosis are alive. Of six patients with initial cord involvement, three are alive. The one patient with a positive cytology died. Four of 13 unstaged patients are alive and well. There was no difference in survival between patients under 5 years of age and those over 5 years of age for either series of patients. Children under 5 years of age, when compared to older children, were more likely to have cord involvement at diagnosis. The optimum radiation dose to the cord in children without evidence of dissemination is unknown. Four long-term survivors received less than or equal to 2600 rad to the cord.