Thirty-eight patients with newly diagnosed medulloblastoma were studied with myelography and cerebrospinal fluid (CSF) cytology studies before radiotherapy. Seventeen (45%) patients had evidence of dissemination beyond the posterior fossa. Spinal cord lesions were demonstrated in ten patients (26%). Negative results of CSF cytology studies did not preclude demonstration of cord involvement. Children younger than 5 years were more likely than older patients to have spinal cord involvement at diagnosis. Patients who were truly M-O did better in terms of absolute survival but not relapse-free survival when compared with patients with dissemination. Myelography and cytology studies are necessary in the evaluation of all newly diagnosed patients with medulloblastoma and may also be indicated for patients with other brain tumors with a known propensity for dissemination.
Cancer 561763-1766. 1985.
TAGING BRAIN TUMORS is a relatively new concept.
S It is especially important for medulloblastomas which, unlike most brain neoplasmas, have a propensity to disseminate beyond the posterior fossa. The purposes of staging a tumor are: (1) the assignment of prognosis, (2) the individualization of treatment, and (3) the facilitation of result comparisons between different institutions. These purposes are fulfilled by uniformly staging all newly diagnosed medulloblastoma patients with myelography, cerebrospinal fluid cytology, and computerized tomography of the brain.
Methods
Beginning in 1974, myelograms were obtained routinely on all newly diagnosed patients with medulloblastoma at the University of Pittsburgh Health Center.'-3 Usually, cerebrospinal fluid (CSF) obtained at the time of myelography was examined for malignant cells. Whenever possible, fluid from a shunt was also examined for malignant cells. The initial purpose was to identify patients with drop metastasis who would then be given additional radiotherapy to involved areas of the spinal cord. Before 1974, a wide range of dosages had been