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The standard treatment in children with average-risk medulloblastoma (MB) is reduced-dose radiotherapy (RT) followed by chemotherapy. However, in adults, there is no agreement on the use of adjuvant chemotherapy. We performed a retrospective analysis of adult MB patients with average-risk disease, defined as no postsurgical residual (or ≤1.5 cm(2)) and no metastatic disease (M0). Main inclusion criteria were: age >16 years, post-surgical treatment with craniospinal irradiation with or without adjuvant chemotherapy (cisplatin and etoposide ± cyclophosphamide). From 1988 to 2012 were accrued 43 average-risk MB patients treated with surgery and adjuvant RT. Fifteen (34.9 %) patients received also chemotherapy: 7 before RT, 5 after RT, and 3 before and after RT. Reasons to administer chemotherapy were presence of residual disease (even if ≤1.5 cm) and delay in RT. After a median follow up time of 10 years (range: 8-13), median survival was 18 years (95 % CI 9-28) in patients who receive RT alone, and was not reached in patients treated with RT plus chemotherapy. The survival rates at 5, 10 and 15 years were 100 %, 78.6 % (95 % CI 60.0-97.2 %) and 60.2 % (95 % CI 36.9-83.5 %), in patients treated with RT alone, and 100, 100 and 100 %, in patients treated with RT plus chemotherapy (p = 0.079). Our findings suggest a role for adjuvant chemotherapy in the treatment of average-risk MB adult patients. Further improvements might drive to add chemotherapy in average-risk setting with less favourable biological signatures (i.e., non-WNT group).

The evaluation of patients with recurrent symptoms after lumbar disc surgery, is a difficult diagnostic problem. The causes of failure may include recurrent disc herniation, postoperative scarring, arachnoiditis, spinal stenosis, infection and mechanical instability. The most common causes are recurrent herniation and postoperative scarring; the routine x-ray and myelographic differentiation between them is difficult or impossible. High resolution CT has shown some results in the evaluation of the postoperative patients. It requires some knowledge of CT findings of "normal" pictures of the physiologic healing and scarring after disc surgery. We scanned 30 asymptomatic operated patients and 30 patients with recurrent sciatic nerve pain after disc surgery. From our observations result that it is quite impossible to distinguish "normal" scar from asymptomatic fibrosis. The degree and type of fibrosis are not related to recurrent symptoms.