OBJECTIVE: To study the clinical features of children with recurrent medulloblastoma (MB) and treatment regimens. METHODS: A retrospective analysis was performed on 101 children with recurrent MB who were admitted to the hospital from August 1, 2011 to July 31, 2017. The children were followed up to July 31, 2020. The Kaplan-Meier method was used for survival analysis. The Cox regression model was used for multivariate regression analysis. RESULTS: Of the 101 children, 95 underwent remission induction therapy, among whom 51 had response, resulting in a response rate of 54%. The median overall survival (OS) time after recurrence was 13 months, and the 1-, 3-, and 5-year OS rates were 50.5%±5.0%, 19.8%±4.0%, and 10%±3.3% respectively. There was no significant difference in the 5-year OS rate between the children with different ages (< 3 years or 3-18 years), sexes, pathological types, or Change stages, between the children with or without radiotherapy before recurrence or re-irradiation after recurrence, and between the children with different times to recurrence (< 12 months or ≥ 12 months after surgery) ( CONCLUSIONS As for the recurrence of MB, although remission induction therapy again can achieve remission, such children still have a short survival time. Only reoperation can significantly prolong survival time, and therefore, early reoperation can be considered to improve the outcome of children with recurrent MB.
Cerebellar Neoplasms/therapy* ; Child ; Humans ; Medulloblastoma/therapy* ; Neoplasm Recurrence, Local ; Retrospective Studies ; Survival Rate

Six patients with medulloblastoma involving brain stem were treated with surgical excision, irradiation or chemotherapy consisting of ACNU, vincristine and procarbazine from 1982 to 1993. All 6 patients were treated by surgical excision. Chang's staging was from T3b to T4 and radiation therapy was done in 5 patients and chemotherapy was performed in 4 patients. Mena follow up period was 25 months(range 1 to 87 months). The result of treatment for medulloblastomas invading brain stem was unfavorable in general, but radiation therapy combined aggressive chemotherapy after surgical resection could show a good result in some cases.
Brain Stem ; Brain* ; Drug Therapy ; Follow-Up Studies ; Humans ; Medulloblastoma* ; Nimustine ; Procarbazine ; Vincristine

43 patients with medulloblastoma of the posterior fossa were treated at the Department of Neurosurgery Yonsei University College of Medicine from 1981 to 1991. Major treatment were surgery, irradiation, chemotherapy or combination. Mean follow-up was 30 months(range, 1 to 120 months). Kaplan-Meier actuarial survival for all patients 59% at 3 years. Disease free survival was 53% at 3 years. Radiation and treatment period(before 1986 vs after 1986) affected outcome significantly. But other prognosic factors such as age, extent of surgical resection and chemotherapy did not affect outcome statistically. Follow-up more than 3 years showed very low recurrence rate.
Brain Neoplasms ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Medulloblastoma ; Neurosurgery ; Prognosis ; Recurrence

BACKGROUND: 'Eight drugs in a day' was one of the widely used regimen in medulloblastoma. Result of treatment of this regimen and comparison between pre-RT chemotherapy and post-RT chemotherapy were presented. METHODS: Medical records of children who were diagnosed as medulloblastoma and treated with 8 in 1 therapy in Seoul National University Children's Hospital from January 1986 to June 1997 were reviewed. RESULTS: 1) Forty nine cases(male: 30, female: 19) were analyzed. The age at diagnosis was between 3 months and 15 years 3 months and median age was 7 years 10 months. 2) The T stage by Chang classification revealed T1(2%), T2(26%), T3a(9%), T3b(56%), and T4(7%) in 43 cases. M stage revealed M0(46%), M1(15%), M3(37%), and M4(2%) in 41 cases. The surgical results revealed gross total resection(36%), near total resection(18%), subtotal resection(38%), and partial resection(9%). 3) The 5-yr disease free survival(DFS) rate of all tumors was 53%. There was no difference in DFS about sex, age, pathology, T stage, M stage, and surgical result. 4) Difference of 5-year DFS between pre-RT chemotherapy group(53%) and post-RT chemotherapy group(83%) was significant[-2Log(LR), P=0.023], excluding the patient relapsed or too young(below 18 month, who had more chemotherapy to delay radiation) to be received radiation therapy. CONCLUSIONS: DFS in post-RT chemotherapy was better than pre-RT chemotherapy. As medulloblastoma has the property to confine in CNS system, prior treatment with radiation as a intensive local therapy may be more effective than the systemic chemotherapy. Progression or relapse were the main causes of treatment failure. Result of treatment may be improved by more intensive therapy.
Child ; Classification ; Diagnosis ; Drug Therapy* ; Female ; Humans ; Medical Records ; Medulloblastoma* ; Pathology ; Recurrence ; Seoul ; Treatment Failure

No abstract available.
Brain Neoplasms* ; Brain* ; Drug Therapy ; Medulloblastoma ; Neoplasm Metastasis* ; Neuroectodermal Tumors, Primitive

Child ; Child Welfare ; Humans ; Medulloblastoma ; drug therapy ; epidemiology ; surgery ; Mortality ; Radiotherapy ; Singapore ; epidemiology ; Treatment Outcome

Posterior leukoencephalopathy syndrome(PLES) is a rare neurological complication which is associated with malignant hypertension, pre-eclampsia, and some drugs including immunosuppressive agents. A 9-year-old boy who had cerebellar medulloblastoma showed seizure on the seventeenth day after intravenous chemotherapy including ACNU and vincristine. Radiologic findings were consistent with those of PLES due to vasospasm. After hypertensive therapy, the symptoms were improved. We present a case of PLES with medulloblastoma which developed following chemotherapy with the regimen of medulloblastoma in a child.
Child* ; Drug Therapy* ; Humans ; Hypertension, Malignant ; Immunosuppressive Agents ; Leukoencephalopathies ; Male ; Medulloblastoma* ; Nimustine ; Posterior Leukoencephalopathy Syndrome* ; Pre-Eclampsia ; Seizures ; Vincristine

The authors experienced 2 cases of medulloblastoma in which active hemorrhage occurred after external ventricular drainage(EVD). A 5 year-old girl suffered from cerebellar fit and brain CT scan showed severe hydrocephalus. So EVD was performed and the pressure was measured about 80 cm H2O. After a gradual reduction of EVD pressure for 15 minutes, fresh blood gushed out through the EVD catheter. The other case was a 7 year-old girl whose tumor bled after intraoperative EVD, just before dural incision. Both tumors were highly vascular in operative field. The first case was bed-ridden at 5 months after surgery and the second case was on postoperative chemotherapy in a good general condition with minimal neurological deficits. Previous reports in the literatures including 2 cases of hemorrhage associated with EVD in medulloblastoma were reviewed. The relatively high incidence of tumor hemorrhage in medulloblastoma and its detrimental influence on the outcome are emphasized.
Brain ; Catheters ; Child ; Child, Preschool ; Drainage* ; Drug Therapy ; Female ; Hemorrhage* ; Humans ; Hydrocephalus ; Incidence ; Medulloblastoma* ; Tomography, X-Ray Computed

PURPOSE: In medulloblastoma, craniospinal radiation therapy combined with chemotherapy improves the prognosis of tumors but results in significant endocrine morbidities. We studied the endocrine morbidity, especially growth pattern changes. METHODS: The medical records of 37 patients with medulloblastoma were reviewed retrospectively for evaluation of endocrine function and growth. We performed the growth hormone stimulation test in 16 patients whose growth velocity was lower than 4 cm/yr. RESULTS: The height loss was progressive in most patients. The height standard deviation score (SDS) decreased from -0.1+/-1.3 initially to -0.6+/-1.0 after 1 year(P<0.01). Growth hormone deficiency(GHD) developed in 14 patients. During the 2 years of growth hormone(GH) treatment, the improvements of height gain or progressions of height loss were not observed. Twelve patients(32.4 percent) revealed primary hypothyroidism. One of six patients diagnosed with compensated hypothyroidism progressed to primary hypothyroidism. Primary and hypergonadotropic hypogonadism were observed in two and one patients respectively. There was no proven case of central adrenal insufficiency. CONCLUSION: Growth impairment developed frequently, irrespective of the presence of GHD in childhood survivors of medulloblastoma. GH treatment may prevent further loss of height. The impairment of the hypothalamic-pituitary-gonadal and hypothalamic-pituitary-thyroidal axis is less common, while central adrenal insufficiency was not observed.
Adrenal Insufficiency ; Axis, Cervical Vertebra ; Child* ; Drug Therapy ; Growth Hormone ; Humans ; Hypogonadism ; Hypothyroidism ; Medical Records ; Medulloblastoma* ; Prognosis ; Retrospective Studies ; Survivors

The author analyzed 15 children with medulloblastoma confirmed histopathologically at the Department of Neurosurgery of the Hanyang University Hospital from Jan. 1981 to Jan. 1989. The results were as followings : 1) The mean age of incidence was 9.3 years and male to female ratio was 2 : 1. 2) The most common symptoms were those of increased intracranial pressure noted in all cases(100.0%), cerebellar symptoms and signs in 7 cases(46.7%) and the brain stem symptoms and signs in 2 cases(13.3%). The symptom duration varied from 7 to 180 days with a mean of 60 days. 3) In the majority of patients(12 cases, 80.0%), tumor was located in the midline on the computed tomographic scanning of the brain and as less typical features of the medulloblastoma, calcification and cystic or necrotic zone within the tumor mass occurred in 5 cases(33.3%) and in 6 cases(40.0%) respectively, suggesting higher frequency than observed in other articles. 4) The tumors with calcification within tumor mass were larger in size and presented with longer symptom duration than those without calcification. And tumors with cystic or necrotic zone within tumor mass were larger in size and presented with shorter symptom duration than those without such lesions. 5) Among 8 cases managed with various degree of surgical resections and full doses of postoperative radiotherapy, spinal metastasis occurred in 1 case(12.5%) at 26 months after the operation. 6) In conclusion, aggressive therapeutic approach with combined modalities, utilizing radical resection of the tumor, scheduled postoperative radiotherapy and chemotherapy, seemed to exert beneficial influence on the outcome, with no evidence of disease in 4 out of 6 cases during the follow up period of 8 to 27 months.
Brain ; Brain Stem ; Child* ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Incidence ; Intracranial Pressure ; Male ; Medulloblastoma* ; Neoplasm Metastasis ; Neurosurgery ; Radiotherapy