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Quinones MC, Bélanger K, Lemieux Blanchard É, Lemieux B, Bahary JP, Masucci LG, Roberge D, Menard C, Lambert C, Berthelet F, Moumdjian R, Florescu M. Adult Medulloblastoma Demographic, Tumor and Treatment Impact since 2006: A Canadian University Experience. ACTA ACUST UNITED AC 2021; 28:3104-3114. [PMID: 34436037 PMCID: PMC8395420 DOI: 10.3390/curroncol28040271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/10/2021] [Accepted: 08/11/2021] [Indexed: 11/29/2022]
Abstract
Medulloblastoma is an aggressive primary brain tumor that is extremely rare in adults; therefore, prospective studies are limited. We reviewed the information of all MB patients treated at the CHUM between 2006 and 2017. We divided our cohort by age and further divided adult patients (53%) in two groups, those diagnosed between 2006–2012 and 2013–2017. In our adult population, median follow up was 26 months and SHH-activated MB comprised 39% of tumors. Adult 5yOS was 80% and first-line therapy led to a 5yPFS of 77%. The absence of radiosensitizing chemotherapy (100% vs. 50%; p = 0.033) negatively influenced 5yPFS. 96% of adult patients received radiotherapy and 48% of them received concomitant radiosensitizing chemotherapy. Complete surgical resection was performed on 85% of adults, but the extent of resection did not have a discernable impact on survival and did not change with time. Adjuvant chemotherapy did not clearly affect prognosis (5yOS 80% vs. 67%, p = 0.155; 5yPFS 78% vs. 67%, p = 0.114). From 2006–2012, the most common chemotherapy regimen (69%) was Cisplatinum, Lomustine and Vincristine, which was replaced in 2013 by Cisplatinum, Etoposide and Cyclophosphamide (77%) with a trend for worse survival. Nine patients recurred and seven of these (78%) were treated with palliative chemotherapy. In conclusion, we did not identify prognostic demographic or tumor factors in our adult MB population. The presence of radiosensitizing chemotherapy was associated with a more favorable PFS. Cisplatinum, Lomustine and Vincristine regimen might be a better adjuvant chemotherapy regimen.
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Affiliation(s)
| | - Karl Bélanger
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Émilie Lemieux Blanchard
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Bernard Lemieux
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Jean-Paul Bahary
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Laura G. Masucci
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - David Roberge
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Cynthia Menard
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Carole Lambert
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - France Berthelet
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Robert Moumdjian
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
| | - Marie Florescu
- CHUM Research Centre (CrCHUM), Department of Hematology and Oncology, Centre Hospitalier de l’Université de Montréal (CHUM), Montreal, QC H2X 3E4, Canada; (K.B.); (É.L.B.); (B.L.); (J.-P.B.); (L.G.M.); (D.R.); (C.M.); (C.L.); (F.B.); (R.M.); (M.F.)
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Abstract
Three healthy adult males developed acute renal failure following cocaine abuse. Muscle pain, tenderness, elevated levels of serum muscle enzymes, heme-positive urine and the presence of pigmented granular casts in urine all indicated occurrence of rhabdomyolysis. One of them developed acute compartmental syndrome of the left leg and required emergency fasciotomy. The course of renal failure and fast recovery were suggestive of acute tubular necrosis in all 3 patients. A possible role of cocaine in the aggravation of renal and/or muscle ischemia has been speculated.
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Affiliation(s)
- P Singhal
- Department of Medicine, Queens Hospital Center, Jamaica, N.Y
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