Medulloblastoma. A review of the LDS hospital experience

A review of 14 patients with an initial diagnosis of medulloblastoma treated with irradiation therapy is presented. Follow-up data are available on all patients. When one evaluates those patients who were treated with total CNS irradiation in ours and other institutions, an excellent five-year survival of approximately 70% is observed. The point of significance is that the dose to the spinal axis was in the range of 2500 rads for the majority of the survivors with a boost to the posterior fossa between 4500 and 5000 rads. Only one patient had metestetic disease, and that was a patient who had a ventricular atrial shunt placed initially for control of increased intracranial pressure. These survival data add to already published data from Hope-Stone and others reporting excellent five-year survival with total CNS irradiation and are contradictory to the reports of approximately 40% five-year survival. The implications of the following review are that one can question the necessity of taking all patients with medulloblastoma to 3500 rads to the spinal column. We would suggest that if no clinical or laboratory evidence exists for spinal involvement, the use of a low dose to the spinal column of approximately 2500 rads decreases the potential for spinal column arrest in this young group of patients.