Vincristine Sulphate in the Treatment of Skeletal Metastases from Cerebellar Medulloblastoma

Abstract

T HE most common site for metastatic deposits from a cerebellar medulloblastoma is the spinal subarachnoid space; distant spread of this malignant tumor usually takes place via the cerebrospinal fluid pathways. Extracranial metastases may occur after surgery, but metastases outside the central nervous system are extremely rare. There are a number of reports of confirmed extracranial metastases of medulloblastoma.l,~,4-m3,14,aG,rg,~0,~z,23,-~7 Weiss ~4 formulated four criteria to aid in the establishment of a definite relationship between the primary growth and the secondary deposits: 1. The proven presence of a single histologically characteristic tumor of the central nervous system, 2. A clinical history which demonstrated that this tumor accounted for the initial symptoms, 3. A complete necropsy to exclude the presence of another primary site, 4. Identical morphology of primary lesion and metastases with due allowances for difference of anaplasia. We are describing two additional cases of skeletal metastases that meet these criteria. The two patients have received cytotoxic drug therapy and are still living. Lassman et al., 9-~2 have noted that many of the malignant intracranial gliomas of childhood may improve and the patients live longer when treated with vincristine sulphate (Oncovin*). These two cases of medulloblastoma became radio-resistant, developed bony metastases, and then responded to treatment with this drug.