recurrent medulloblastoma

    
      Re: recurrent medulloblastoma
    


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Posted by ccf neuro M.D. on June 01, 1997 at 13:39:39:

In Reply to: recurrent medulloblastoma posted by Jared Stoehr on May 24, 1997 at 20:12:51:

: 26 yr old female diagnosed in 1/93 with medulloblastoma.  Treated with 90% resection, chemo and csi putting her into complete clinical remission for nearly 4 yrs.  Follow-up MRI on 2/97 shows a mass developing in the right basal ganglia and temporal lobe.  Histological confirmation of recurrent tumor was obtained through stereotactic biopsy on 3/4/97.  Successful stem cell apheresis followed and we began treatment with 2 cycles of increasingly semi-high dose cyclophosphamide to see how her body would respond given the extent of previous treatment.  Myleosuppression was overcome within 14 days on both cycles with the help of gm-csf - her bone marrow remains strong.  We were hoping for a response from the tumor as well but on 5/12/97 an MRI showed increasing tumor 2.6 x 4.8 cm with slight mass effect but no other lesions noted.  All other tests are negative for tumor and heart/lungs remain strong.  Our original neurosurgeon will not operate in this area likely due to the presence of multiple local blood vessels and the seemingly high risk of morbidity.  At this point, another MRI is scheduled for 5/29/97 to rule out the possiblility of a "fake" gadolinium enhancement, to see if the tumor is having a delayed response to the cytoxan, and to see how fast the tumor may be growing.  Our oncologist's opinion is that if the tumor is still growing we may need to opt for surgery (open, cyro or stereotactic) if the associated morbidity/mortality risks are reasonable.  If surgery is an option, we're told that the Cleveland Institution is the place to be.  We're not backed into a corner yet with the possibilities of HDC/PSCT and further radiation, but we may need to decrease the mass if she is to sustain further treatment.  At this time, she remains asymptomatic and in good spirits despite the poor prognosis.  Something interesting to note is that 9 months ago she was put on premarin and methodoxyprogesterone due to premature ovarian failure from the prior treatments, I've read that brain tumors and specifically medulloblastoma often have estrogen receptor's - could this have caused the dormant malignant cells to grow?  Does this sound like a case that your neurosurgeons could or would take?  Scans, MRI's, pathology reports and profile can be made available.  Information on your phase II protocol of continuous infusion Thiotepa would be helpful as well.  Sloan-Kettering and Duke have shown some promising studies treating recurrent medulloblastoma with various combinations of drugs given in supra-lethal doses followed by BMT, so that's the path we're hoping to follow at this point.  I can be reached at 703-691-6659 or 703-242-1154 and would appreciate any correspondence.  Thanks in advance.
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Jared, this is obviously a complex case. I was able to find only ONE (!!!) article on estrogen receptor ecpression in medulloblastomas (Cancer. 75(10):2571-2578). Although the majority of medulloblastomas did express estrogen receptor-related antigen, so did the majority of a bunch of other tumors. Your question reminded me of a case I personally saw where a very young woman become pregnant and suffered tremendous growth of and then hemorrhage of a meningioma, a susually benign tumor that is often estrogen receptor positive; thus, your theory is not necessarily unreasonable, although there is obviously no way to clearly prove (or disprove) it, especially given the inherent tendency for medulloblastomas to recur. Regarding your questions about ongoing trials and case-specific treatment options, I'm going to suggest that you contact Dr. Bruce Cohen of our neurooncology department. His direct office number is: (216)-444-9282. He could give you details of ongoing trials. If you would be interested in a second
opinion for the patient, I would suggest specifically making an appointment at our brain tumor clinic, where you could see Dr. Cohen and/or Dr. Gene Barnett, our chief neurooncologic surgeon. His office number is 216-444-5569. Without seeing the actual scans, it is not possible to give you more specific advice; information provided in the forum is intended for general informational purposes only and actual diagnosis and treatment of your specific illness should be in conjunction with your treating physician(s).