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.