Medulloblastoma: survival and late recurrence after the Collins' risk period.

Sixty-three patients with cerebellar medulloblastoma were treated between 1963 and 1992 at our institution. Among them, 10 patients have survived beyond the Collins' risk period. These included 6 males and 4 females who ranged in age from 6 months to 12 years at the time of diagnosis. A total removal of the tumor was achieved in 4 patients, while there was a subtotal removal in 3, and a partial removal in 3. Histologically, 6 tumors were classified as a classical type of medulloblastoma, and 4 were diagnosed as being a desmoplastic type. Postoperatively, 9 patients received craniospinal radiation therapy, and one received local radiation to the primary site. During the follow-up period of 3.9-25.4 years, 5 patients have been in continuous remission for from 14.2 to 25.4 years and are leading normal lives, 2 have survived for 18.1 and 18.5 years with mild to moderate neurological deficits, while the remaining 3 died after the Collins' risk period. Two out of these last 3 patients were under the age of one year at the time of onset, while the remaining one died after a second recurrence. We conclude that careful follow-up is needed for all long-term survivors even after the Collins' risk period, especially for those who were under the age of 1 year at onset and who failed in the initial treatments.