© Copyright 2008 by the Society for Neuro-Oncology
Received January 17, 2008
Accepted April 1, 2008
Efficacy of high-dose chemotherapy or standard salvage therapy in patients with recurrent medulloblastoma
Sridharan Gururangan 1*,
Jeanne Krauser 2,
Melody A. Watral 2,
Tim Driscoll 3,
Nicole Larrier 4,
David A. Reardon 1,
Jeremy N. Rich 5,
Jennifer A. Quinn 5,
James J. Vredenburgh 6,
Annick Desjardins 7,
Roger E. McLendon 8,
Herbert Fuchs 9,
Joanne Kurtzberg 3,
Henry S. Friedman 10
1 Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA; Department of Pediatrics, Duke University Medical Center, Durham, NC, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA
2 Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA
3 Department of Pediatrics, Duke University Medical Center, Durham, NC, USA; Department of Bone Marrow Transplant, Duke University Medical Center, Durham, NC, USA
4 Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
5 Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA; Department of Neurology, Duke University Medical Center, Durham, NC, USA
6 Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA; Department of Medicine, Duke University Medical Center, Durham, NC, USA
7 Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA; Department of Neurology, Duke University Medical Center, Durham, NC, USA
8 Department of Neuropathology, Duke University Medical Center, Durham, NC, USA
9 Department of Surgery, Duke University Medical Center, Durham, NC, USA
10 Preston Robert Tisch Brain Tumor Center, Duke University Medical Center, Durham, NC, USA; Department of Surgery, Duke University Medical Center, Durham, NC, USA
* To whom correspondence should be addressed. E-mail: gurur002{at}mc.duke.edu.
 |
Abstract |
|---|
The efficacy of high-dose chemotherapy (HDC) or standard salvage therapy was evaluated in patients with recurrent medulloblastoma (MBL) using retrospective chart review of all patients with recurrent MBL treated at Duke University Medical Center between 1995 and 2005 and who had undergone HDC with or without radiotherapy (RT) or standard salvage therapy after relapse. A total of 30 patients were diagnosed with recurrent MBL after standard RT alone or chemotherapy with RT. Nineteen patients (7 who received no RT before recurrence [group A] and 12 who received definitive RT before recurrence [group B]) underwent surgery and/or induction chemotherapy followed by HDC plus autologous stem-cell rescue. Eleven patients (group C) underwent standard salvage therapy. Six of seven group A patients also received standard RT just before or after recovery from HDC, and 5 of 12 group B patients received adjuvant palliative focal RT post-HDC. At a median follow-up of 28 months, three of seven patients in group A are alive and disease-free at 
34, 110, and 116 months, respectively, post-HDC. All patients in groups B and C have died of tumor, at a median of 35 months and 26 months from HDC and standard salvage therapy, respectively. HDC or standard salvage therapy was ineffective in our patients with recurrent MBL who had received standard RT before recurrence. The favorable impact of HDC on disease control in the two long-term survivors cannot be clearly established due to the cofounding effect of definitive RT postrecurrence.
Key Words:
angiogenesis, Avastin, bevacizumab, biomarkers, glioblastoma, glioma
CiteULike 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
