Embryonic tumours of the central nervous system

Evidence in medulloblastomas

Medulloblastoma is the most common infratentorial malignant tumour under 15 years of age. In recent protocols, the patients are stratified for treatment in standard risk or high risk, according to the clinical variables as age, localized or disseminated disease, degree of surgical resection and more recently expected biological behaviour based on retrospective and prospective studies of former samples analyzed. The objectives for future treatments are reduce morbidity without jeopardizing survival.

[Differential aspects in children and adult patients with medulloblastoma]

BACKGROUND AND OBJECTIVE

Medulloblastoma is the more frequent malignant cerebral tumor in childhood.

PATIENTS AND METHODS

This is an observational study of a retrospective cohort in which there were included all the patients diagnosed of medulloblastoma in the last 19 years (1989-2007) in Hospital de Cruces of Baracaldo, Vizcaya, Spain.

RESULTS

There were included 37 patients, 20 men and 17 women, with ages between 1 and 48 years (average age 13.7 years with standard deviation 11.4). Tumor site and mortality according to initial dissemination were variables of statistic significance. Metastases were detected at diagnosis in two patients. The surgical resection was total in 75% of the patients. A relapse was diagnosed in the follow-up in 59.5% of the patients, with a positive spinal fluid in 27%. Sequelae were detected in 100% of the survivors, mainly with cerebellar and ocular alterations. One patient developed a meningioma and a maxillary sarcoma at the long term follow-up. It is important to emphasize the aggressiveness of medulloblastoma in both children and adults, with a global mortality of 56.8% and 48,6% at 5 years.

CONCLUSIONS

It is considered necessary a multidisciplinary treatment and a long term monitoring of the patients and the sequelae of the survivors, including the possibility of second tumours.

Childhood central nervous system tumours – incidence and survival in Europe (1978–1997): Report from Automated Childhood Cancer Information System project

This paper describes the incidence and survival of childhood central nervous system (CNS) tumours in Europe for the period 1978-1997. A total of 19,531 cases, aged 0-14 years, from the ACCIS database were analysed by five regions: the British Isles, East, North, South, and West. Overall age-standardised incidence rate (ASR) of CNS tumours in Europe (1988-1997) was 29.9 per million, with the highest rates in the North. Astrocytoma (ASR=11.8), primitive neuroectodermal tumours (PNET) (ASR=6.5) and ependymoma (ASR=3.4) were the most frequent types. Incidence increased significantly during 1978-1997, on average by 1.7% per year. Diagnostic methods may partially explain incidence rates and trends, although a role of variations in risk factors cannot be excluded. Overall 5-year survival was 64% and varied between 72% in the North and 53% in the East. PNET had the poorest prognosis (49%) and astrocytoma the best (75%). Survival has improved by 29% since late 1970s. The positive trends were seen in all regions, although the interregional differences persisted, as a reflection of the different healthcare systems.