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Vol. 22. Núm. 6.Enero 2011Páginas 488-607
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Vol. 22. Núm. 6.Enero 2011Páginas 488-607
DOI: 10.1016/S1130-1473(11)70104-X
Meduloblastomas del adulto: serie quirúrgica de 11 casos
Adult medulloblastomas: our experience
Visitas
1780
R. Rodríguez-Mena??
Autor para correspondencia
ruben.rod@gmail.com

Correspondencia: Servicio de Neurocirugía. Consorcio Hospital General Universitario de Valencia. Avda. Tres Cruces, 2. E-46014 Valencia.
, R.A. Barbella-Aponte, J.M. Gallego-Sánchez, C. Barcia-Mariño
Servicio de Neurocirugía. Servicio de Anatomía Patológica. Consorcio Hospital General Universitario de Valencia. Valencia. España
Visitas
1780
Información del artículo
Resumen
Introducción

Los meduloblastomas son tumores malignos, invasivos, altamente celulares, del cerebelo, infrecuentes en el adulto. En el presente trabajo describiremos la experiencia en el manejo de esta patología en nuestro centro.

Material y métodos

Se trata de un trabajo retrospectivo que incluyó 11 pacientes adultos con diagnóstico de meduloblastoma del eje craneoespinal atendidos entre 1984–2010. Se evaluaron datos clínicos, radiológicos y terapéuticos durante la evolución de la enfermedad.

Resultados

La edad media de los pacientes fue 30,2 años (9 mujeres y 2 varones). Más del 80% de los pacientes manifestaron clínica de hipertensión intracraneal, mientras el 54,5% presentaron síndrome cerebeloso. El grado de resección quirúrgica fue total en 8 pacientes (72,7%) y subtotal en 3 (27,3%). Todos los pacientes recibieron tratamiento radioterápico adyuvante. Posterior a la exéresis tumoral inicial, 6 pacientes recibieron quimioterapia adyuvante con cisplatino (CDDP) y etopósido (VP-16). Durante el seguimiento, después de un tiempo medio de 35,2 meses, se observaron recidivas en el 36,4% de los pacientes (n=4), con mayor frecuencia en la fosa posterior, empleando en todos ellos tratamiento con cirugía y quimioterapia. El tiempo medio de supervivencia fue 100,3 meses, con un índice de supervivencia estimado a los 5 y 8 años de seguimiento del 84 y 56% respectivamente.

Conclusiones

La máxima resección quirúrgica forma parte crucial del tratamiento, seguida de adyuvancia oncológica tan pronto sea posible, con radioterapia seguida o no de quimioterapia.

Palabras clave:
Adulto
Cirugía
Meduloblastoma
Quimioterapia
Radioterapia craneoespinal
Abreviaturas:
CDDP
DVP
ECOG
IRM
LCR
QT
RT
TC
VP-16
Summary
Introduction

Medulloblastomas are malignant, invasive and highly cellular tumours from the cerebellum, rarely seen in adults. We describe the experience in the treatment of this entity in our institution.

Materials and methods

A retrospective study was made including 11 adult patients with medulloblastomas confined to the craniospinal axis treated between 1984–2010. Clinical, radiological and therapeutic data were assessed during the evolution of this entity.

Results

Mean age of patients was 30,2 years (9 women/2 men). Over 80% of the patients presented intracranial hypertension, while 54,5% presented cerebellum syndrome. Gross total surgical resection was achieved in 8 patients (72,7%) and subtotal resection in the other 3 (27,3%). All patients received craniospinal radiotherapy. After primary surgical resection, 6 patients received chemotherapy with cisplatin (CDDP) and etoposide (VP-16). During the follow up period and after a median time of 35,2 months, 4 patients (36,4%) presented with relapse, mainly in the posterior cranial fossa, managed in the majority of cases with surgical resection plus additional chemotherapy. Mean survival time was 100,3 months with a 5- and 8- year overall survival rate of 84 and 56% respectively.

Conclusions

In the treatment of this malignancy, gross surgical resection has a crucial role, followed as soon as possible by oncological therapy, specially radiotherapy and chemotherapy if needed.

Key words:
Adult
Chemotherapy
Craniospinal radiotherapy
Medulloblastoma
Surgery
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Rodríguez-Mena, R.; Barbella-Aponte, R.A.; Gallego-Sánchez, J.M.; Barcia-Mariño, C.: Meduloblastomas del adulto: serie quirúrgica de 11 casos. Neurocirugía 2011; 22: 488–497.

Copyright © 2011. Sociedad Española de Neurocirugía
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