GERALDINA POGGI - Academia.edu (original) (raw)

Papers by GERALDINA POGGI

Electronics Letters, 1993

5 TIWARI, S., HINTZMAN, J., and CALLEGARI, A.: 'Rapid thermal diffu-sion and ohmic contacts ... more 5 TIWARI, S., HINTZMAN, J., and CALLEGARI, A.: 'Rapid thermal diffu-sion and ohmic contacts using zinc in GaAs and GaAIAs', AppL Phys. ... 5th April 1993 0 IEE 1993 G. Poggi (Uniuersita di Napoli, Dipartrmento di Ingegneria Elettronica, Via Claudio, 21 1-80125 Napoli, Italy ...

informatic tecnology can be the fight answer to deal with some nettropsychological troubles of ch... more informatic tecnology can be the fight answer to deal with some nettropsychological troubles of children. The goal of this study is the application of ctmaputer programa as a possible strategy in rehabilitation of children with cognitive problems. Four programs were selected to stimulate various basic brain fanetions: problem solving, categor/r~tion, logical sequence and spA~ thought. The programs were tested on a group of 20 mentally retarded young subjects matched with a comparison group of 20 like subjects trained with o~.ary teclmiques. The computer trained group showed a significant improvement in tests involving attention, motivation for learning and problem solving abilities. These results, in our opinion, would confirm the usefulness of specific soRwam as a rehabilitative method in dealing with cognitive problems of children.

Disability and Rehabilitation, 2009

Disability and Rehabilitation, 2008

To present a cognitive-behavioural stimulation (CBS) protocol designed to help severely damaged p... more To present a cognitive-behavioural stimulation (CBS) protocol designed to help severely damaged patients in the early post-acute stage by describing the underlying methodology and assessing its efficacy compared to traditional rehabilitation methods. This protocol combines multisensory stimulation and cognitive-behavioural techniques to elicit and intensify the occurrence of adaptive responses and reduce maladaptive behavioural patterns. A control group and an experimental group--both evaluated with the Levels of Cognitive Functioning Assessment Scale (LOCFAS)--were compared at the beginning of the rehabilitation programme and at the end of it. The control group consisting of patients assessed and treated before receiving the CBS protocol was enrolled in a traditional rehabilitation programme (only physical therapy and speech therapy). Besides the traditional therapy, the experimental group also received the CBS protocol. Patients on the CBS protocol show a greater improvement and are therefore more responsive than the control group after the 16-week remediation programme. The mean LOCFAS improvement of the experimental group is more marked during the first month of rehabilitation and is associated to the entry LOCFAS level, while in the control group the improvement on LOCFAS is considered to be 'spontaneous' and is associated to the aetiology of the brain damage. Our results show a better initial outcome for patients receiving the CBS protocol.

International Journal of Radiation Oncology Biology Physics, 2006

recognized. The aims of this study are to confirm the incidence of pseudo-progression, to determi... more recognized. The aims of this study are to confirm the incidence of pseudo-progression, to determine the effect on prognosis, and to explore the implications regarding early follow-up imaging. Materials/Methods: All patients receiving RT/TMZ for newly diagnosed glioblastoma were identified using a prospective database. Clinical and radiographic outcomes were retrospectively reviewed. Early progression was defined as radiological progression (RECIST criteria) during or within 8 weeks of completing RT/TMZ. Pseudo-progression was defined as early progression but with subsequent disease stabilization, without salvage therapy, lasting for at least 6 months from completion of RT/TMZ. If the patient continued to progress or died due to glioblastoma within 6 months of completing RT/TMZ, then this was labeled as genuine early progression. The primary outcome was overall survival (OS) calculated from the date of surgery using the Kaplan-Meier method. Log-rank analysis was used to compare groups. Results: To date, 77 patients have been analyzed. The median age was 58 years (range, 18-80 years) and the median number of adjuvant TMZ cycles administered was 2 (range, 0-13). Early follow-up imaging was not available in 3 patients. Early progression occurred in 23/74 patients (31%) and 8/23 (35%) of these patients had pseudo-progression. Median OS for the entire cohort was 55 weeks (95% CI, 47-63 weeks) and 59 weeks (95% CI, 46-73 weeks) for 67 patients who received a biological equivalent dose (using an alpha/beta ratio of 10) of at least 60 Gy 10 . Median OS for patients with no early progression was 67 weeks (95% CI, 46-88 weeks), pseudo-progression 83 weeks (95% CI, 25-141 weeks), and genuine early progression 33 weeks (95% CI, 20-46 weeks). Patients with pseudo-progression had a significantly longer median OS compared to those with genuine early progression (p = 0.013).

Le Gravi Cerebrolesioni Acquisite (GCLA) rappresentano sempre più un problema ad alta rilevanza m... more Le Gravi Cerebrolesioni Acquisite (GCLA) rappresentano sempre più un problema ad alta rilevanza medica e sociale anche in età evolutiva. Per GCLA si intendono, secondo le linee guida italiane, le patologie acquisite (traumatiche, anossiche, infettive…) che determinano nel soggetto un coma grave in fase acuta (GCS <8). Alcuni lavori descrivono l'outcome a distanza dal "traumatic brain injury" in età infantile 1,2 , pochi analizzano le varie eziologie 3 .

International Journal of Radiation Oncology Biology Physics, 2008

Brain necrosis or other subacute iatrogenic reactions has been recognized as a potential complica... more Brain necrosis or other subacute iatrogenic reactions has been recognized as a potential complication of radiotherapy (RT), although the possible synergistic effects of high-dose chemotherapy and RT might have been underestimated. We reviewed the clinical and radiologic data of 49 consecutive children with malignant brain tumors treated with high-dose thiotepa and autologous hematopoietic stem cell rescue, preceded or followed by RT. The patients were assessed for neurocognitive tests to identify any correlation with magnetic resonance imaging (MRI) anomalies. Of the 49 children, 18 (6 of 25 with high-grade gliomas and 12 of 24 with primitive neuroectodermal tumors) had abnormal brain MRI findings occurring a median of 8 months (range, 2-39 months) after RT and beginning to regress a median of 13 months (range, 2-26 months) after onset. The most common lesion pattern involved multiple pseudonodular, millimeter-size, T1-weighted unevenly enhancing, and T2-weighted hyperintense foci. Four patients with primitive neuroectodermal tumors also had subdural fluid leaks, with meningeal enhancement over the effusion. One-half of the patients had symptoms relating to the new radiographic findings. The MRI lesion-free survival rate was 74%+/-6% at 1 year and 57%+/-8% at 2 years. The number of marrow ablative courses correlated significantly to the incidence of radiographic anomalies. No significant difference was found in intelligent quotient scores between children with and without radiographic changes. Multiple enhancing cerebral lesions were frequently seen on MRI scans soon after high-dose chemotherapy and RT. Such findings pose a major diagnostic challenge in terms of their differential diagnosis vis-à-vis recurrent tumor. Their correlation with neurocognitive results deserves further investigation.

Psycho-oncology, 2005

Cognitive and psychological disorders are among the most frequently observed sequelae in brain tu... more Cognitive and psychological disorders are among the most frequently observed sequelae in brain tumor survivors. The goal of this work was to verify the presence of these disorders in a group of children and adolescents diagnosed with brain tumor before age 18 years, differentiate these disorders according to age of assessment, identify correlations between the two types of impairments and define possible associations between these impairments and clinical variables.The study involved 76 patients diagnosed with brain tumor before age 18 years. Three age groups were formed, and all the patients received a standardized battery of age-matched cognitive and psychological tests.According to our findings, all three groups present with cognitive and psychological-behavioral disorders. Their frequency varies according to age of onset and is strongly associated to time since diagnosis. The performance intelligence quotient (PIQ) was more impaired than the verbal intelligence quotient (VIQ). Internalizing problems, withdrawal and social problems were the most frequent psychological disorders. Correlations were found between cognitive impairment and the onset of the main psychological and behavioral disorders.These findings are relevant as they point out the long-term outcome of brain tumor survivors. Hence, the recommendation to diversify psychological interventions and rehabilitation plans according to the patients' age. Copyright © 2004 John Wiley & Sons, Ltd.

Brain Injury, 2005

To define and differentiate psychological and adjustment problems due to brain injury or brain tu... more To define and differentiate psychological and adjustment problems due to brain injury or brain tumour in children and adolescents. Two groups of patients with acquired brain lesions (24 post-traumatic patients and 22 brain tumour survivors), ranging in age between 8-15 years, received a psychological evaluation, including the Child Behaviour Checklist for Ages 4-18 (CBCL) and the Vineland Behaviour Adaptive Scales (VABS). Both groups showed psychological and social adjustment problems. Post-traumatic patients were more impaired than brain tumour survivors. Social adjustment problems were associated to externalizing problems in post-traumatic patients and internalizing problems in brain tumour surviving patients. These differences in psychological and behavioural disorders between the two groups must necessarily be considered when developing psychological treatment, rehabilitation plan and social re-entry.

Critical Reviews in Oncology Hematology, 2011

International Journal of Radiation Oncology Biology Physics, 2006

Introduction Supratentorial primitive neuroectodermal tumors (SPNET) are rare tumors accounting f... more Introduction Supratentorial primitive neuroectodermal tumors (SPNET) are rare tumors accounting for only 2.5% of childhood brain tumors. The purpose of this study was to describe the range of treatment regimens used to treat pediatric SPNET in Canada and to identify prognostic factors for overall survival in this population. Methods This study was a retrospective clinical analysis of SPNET patients treated over the last 10 years in Canada. A questionnaire was developed and distributed to all institutions in Canada who treat pediatric patients. Data were collected for patients <19 years of age who were diagnosed and treated for SPNET between 1995 and 2005.

Journal of Neuro-oncology, 2010

After successfully using cisplatin (30 mg/m 2 / day) and etoposide (150 mg/m 2 /day) in ten three... more After successfully using cisplatin (30 mg/m 2 / day) and etoposide (150 mg/m 2 /day) in ten three-day courses for progressive low-grade gliomas, a subsequent protocol reduced the daily doses of cisplatin (to 25 mg) and etoposide (to 100 mg), with the objective of achieving the same response and three-year PFS rates with lower neurotoxicity and myelotoxicity. We treated 37 patients (median age 6 years); 23 had optochiasmatic tumours and nine were metastatic cases. Diagnoses were clinical in 13 cases and histological in 24, and comprised: pilocytic astrocytoma (17), ganglioglioma (3), pilomyxoid astrocytoma (2), and fibrillary astrocytoma (2). Treatment was prompted by radiological evidence of progression and/or clinical deterioration a median 18 months after the first diagnosis. After initial MRI staging, neurological and clinical examinations were performed before each chemotherapy cycle, with MRI after the first three courses and every three months thereafter. After a median 48 months, a volume reduction was appreciable in 24 cases (65%) and response was maximum 12 months after starting treatment. The three-year EFS and OS rates were 65 and 97%, respectively. Clinical, neurological, or functional improvements were seen in 26/37 cases. No children had a WBC nadir below 2,000/mm 3 . Audiological toxicity caused damage in 4/34 cases. The previous protocol had achieved volume reductions in 70% of cases, causing audiological damage (data updated) in 11/31 (P = 0.023), with three-year PFS and OS rates of 70 and 100%, respectively. Lower doses of cisplatin/etoposide are still effective in progressive lowgrade glioma, with less acute and persistent morbidity.

European Journal of Cancer, 2005

We retrospectively studied 26 consecutive adults treated for medulloblastoma using paediatric pro... more We retrospectively studied 26 consecutive adults treated for medulloblastoma using paediatric protocols. Between 1987 and 2003, patients P18 years old were given adjuvant chemotherapy consisting of one of two ÔpaediatricÕ regimens (depending on the time of presentation) and craniospinal local-boost radiotherapy: regimen A (n = 12), vincristine (VCR), intrathecal and/or intravenous methotrexate and conventional radiotherapy; or regimen B (n = 11) sequencing intensive doses of multiple agents followed by hyperfractionated accelerated radiotherapy (HART). A VCR-lomustine-based maintenance followed both regimens. Three additional patients received a tailored treatment due to their impaired neurological status after surgery. The median age at diagnosis was 26 years (range 18-41 years). With a median follow-up of 46 months, 5-year disease-free and overall survival rates were 65 ± 11% and 73 ± 10%, respectively, for the series as a whole. All patients who received regimen B (5 of whom had metastatic Chang M2-M3 disease) are alive with no evidence of disease at 39 months. Although the number of patients is limited, our data suggest that the sandwich sequential, moderately intensive chemotherapy in combination with HART is an effective treatment for medulloblastoma in adults, and this approach seems to overcome previously-recognised risk factors.

Electronics Letters, 1993

5 TIWARI, S., HINTZMAN, J., and CALLEGARI, A.: 'Rapid thermal diffu-sion and ohmic contacts ... more 5 TIWARI, S., HINTZMAN, J., and CALLEGARI, A.: 'Rapid thermal diffu-sion and ohmic contacts using zinc in GaAs and GaAIAs', AppL Phys. ... 5th April 1993 0 IEE 1993 G. Poggi (Uniuersita di Napoli, Dipartrmento di Ingegneria Elettronica, Via Claudio, 21 1-80125 Napoli, Italy ...

informatic tecnology can be the fight answer to deal with some nettropsychological troubles of ch... more informatic tecnology can be the fight answer to deal with some nettropsychological troubles of children. The goal of this study is the application of ctmaputer programa as a possible strategy in rehabilitation of children with cognitive problems. Four programs were selected to stimulate various basic brain fanetions: problem solving, categor/r~tion, logical sequence and spA~ thought. The programs were tested on a group of 20 mentally retarded young subjects matched with a comparison group of 20 like subjects trained with o~.ary teclmiques. The computer trained group showed a significant improvement in tests involving attention, motivation for learning and problem solving abilities. These results, in our opinion, would confirm the usefulness of specific soRwam as a rehabilitative method in dealing with cognitive problems of children.

Disability and Rehabilitation, 2009

Disability and Rehabilitation, 2008

To present a cognitive-behavioural stimulation (CBS) protocol designed to help severely damaged p... more To present a cognitive-behavioural stimulation (CBS) protocol designed to help severely damaged patients in the early post-acute stage by describing the underlying methodology and assessing its efficacy compared to traditional rehabilitation methods. This protocol combines multisensory stimulation and cognitive-behavioural techniques to elicit and intensify the occurrence of adaptive responses and reduce maladaptive behavioural patterns. A control group and an experimental group--both evaluated with the Levels of Cognitive Functioning Assessment Scale (LOCFAS)--were compared at the beginning of the rehabilitation programme and at the end of it. The control group consisting of patients assessed and treated before receiving the CBS protocol was enrolled in a traditional rehabilitation programme (only physical therapy and speech therapy). Besides the traditional therapy, the experimental group also received the CBS protocol. Patients on the CBS protocol show a greater improvement and are therefore more responsive than the control group after the 16-week remediation programme. The mean LOCFAS improvement of the experimental group is more marked during the first month of rehabilitation and is associated to the entry LOCFAS level, while in the control group the improvement on LOCFAS is considered to be &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;spontaneous&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; and is associated to the aetiology of the brain damage. Our results show a better initial outcome for patients receiving the CBS protocol.

International Journal of Radiation Oncology Biology Physics, 2006

recognized. The aims of this study are to confirm the incidence of pseudo-progression, to determi... more recognized. The aims of this study are to confirm the incidence of pseudo-progression, to determine the effect on prognosis, and to explore the implications regarding early follow-up imaging. Materials/Methods: All patients receiving RT/TMZ for newly diagnosed glioblastoma were identified using a prospective database. Clinical and radiographic outcomes were retrospectively reviewed. Early progression was defined as radiological progression (RECIST criteria) during or within 8 weeks of completing RT/TMZ. Pseudo-progression was defined as early progression but with subsequent disease stabilization, without salvage therapy, lasting for at least 6 months from completion of RT/TMZ. If the patient continued to progress or died due to glioblastoma within 6 months of completing RT/TMZ, then this was labeled as genuine early progression. The primary outcome was overall survival (OS) calculated from the date of surgery using the Kaplan-Meier method. Log-rank analysis was used to compare groups. Results: To date, 77 patients have been analyzed. The median age was 58 years (range, 18-80 years) and the median number of adjuvant TMZ cycles administered was 2 (range, 0-13). Early follow-up imaging was not available in 3 patients. Early progression occurred in 23/74 patients (31%) and 8/23 (35%) of these patients had pseudo-progression. Median OS for the entire cohort was 55 weeks (95% CI, 47-63 weeks) and 59 weeks (95% CI, 46-73 weeks) for 67 patients who received a biological equivalent dose (using an alpha/beta ratio of 10) of at least 60 Gy 10 . Median OS for patients with no early progression was 67 weeks (95% CI, 46-88 weeks), pseudo-progression 83 weeks (95% CI, 25-141 weeks), and genuine early progression 33 weeks (95% CI, 20-46 weeks). Patients with pseudo-progression had a significantly longer median OS compared to those with genuine early progression (p = 0.013).

Le Gravi Cerebrolesioni Acquisite (GCLA) rappresentano sempre più un problema ad alta rilevanza m... more Le Gravi Cerebrolesioni Acquisite (GCLA) rappresentano sempre più un problema ad alta rilevanza medica e sociale anche in età evolutiva. Per GCLA si intendono, secondo le linee guida italiane, le patologie acquisite (traumatiche, anossiche, infettive…) che determinano nel soggetto un coma grave in fase acuta (GCS <8). Alcuni lavori descrivono l'outcome a distanza dal "traumatic brain injury" in età infantile 1,2 , pochi analizzano le varie eziologie 3 .

International Journal of Radiation Oncology Biology Physics, 2008

Brain necrosis or other subacute iatrogenic reactions has been recognized as a potential complica... more Brain necrosis or other subacute iatrogenic reactions has been recognized as a potential complication of radiotherapy (RT), although the possible synergistic effects of high-dose chemotherapy and RT might have been underestimated. We reviewed the clinical and radiologic data of 49 consecutive children with malignant brain tumors treated with high-dose thiotepa and autologous hematopoietic stem cell rescue, preceded or followed by RT. The patients were assessed for neurocognitive tests to identify any correlation with magnetic resonance imaging (MRI) anomalies. Of the 49 children, 18 (6 of 25 with high-grade gliomas and 12 of 24 with primitive neuroectodermal tumors) had abnormal brain MRI findings occurring a median of 8 months (range, 2-39 months) after RT and beginning to regress a median of 13 months (range, 2-26 months) after onset. The most common lesion pattern involved multiple pseudonodular, millimeter-size, T1-weighted unevenly enhancing, and T2-weighted hyperintense foci. Four patients with primitive neuroectodermal tumors also had subdural fluid leaks, with meningeal enhancement over the effusion. One-half of the patients had symptoms relating to the new radiographic findings. The MRI lesion-free survival rate was 74%+/-6% at 1 year and 57%+/-8% at 2 years. The number of marrow ablative courses correlated significantly to the incidence of radiographic anomalies. No significant difference was found in intelligent quotient scores between children with and without radiographic changes. Multiple enhancing cerebral lesions were frequently seen on MRI scans soon after high-dose chemotherapy and RT. Such findings pose a major diagnostic challenge in terms of their differential diagnosis vis-à-vis recurrent tumor. Their correlation with neurocognitive results deserves further investigation.

Psycho-oncology, 2005

Cognitive and psychological disorders are among the most frequently observed sequelae in brain tu... more Cognitive and psychological disorders are among the most frequently observed sequelae in brain tumor survivors. The goal of this work was to verify the presence of these disorders in a group of children and adolescents diagnosed with brain tumor before age 18 years, differentiate these disorders according to age of assessment, identify correlations between the two types of impairments and define possible associations between these impairments and clinical variables.The study involved 76 patients diagnosed with brain tumor before age 18 years. Three age groups were formed, and all the patients received a standardized battery of age-matched cognitive and psychological tests.According to our findings, all three groups present with cognitive and psychological-behavioral disorders. Their frequency varies according to age of onset and is strongly associated to time since diagnosis. The performance intelligence quotient (PIQ) was more impaired than the verbal intelligence quotient (VIQ). Internalizing problems, withdrawal and social problems were the most frequent psychological disorders. Correlations were found between cognitive impairment and the onset of the main psychological and behavioral disorders.These findings are relevant as they point out the long-term outcome of brain tumor survivors. Hence, the recommendation to diversify psychological interventions and rehabilitation plans according to the patients' age. Copyright © 2004 John Wiley & Sons, Ltd.

Brain Injury, 2005

To define and differentiate psychological and adjustment problems due to brain injury or brain tu... more To define and differentiate psychological and adjustment problems due to brain injury or brain tumour in children and adolescents. Two groups of patients with acquired brain lesions (24 post-traumatic patients and 22 brain tumour survivors), ranging in age between 8-15 years, received a psychological evaluation, including the Child Behaviour Checklist for Ages 4-18 (CBCL) and the Vineland Behaviour Adaptive Scales (VABS). Both groups showed psychological and social adjustment problems. Post-traumatic patients were more impaired than brain tumour survivors. Social adjustment problems were associated to externalizing problems in post-traumatic patients and internalizing problems in brain tumour surviving patients. These differences in psychological and behavioural disorders between the two groups must necessarily be considered when developing psychological treatment, rehabilitation plan and social re-entry.

Critical Reviews in Oncology Hematology, 2011

International Journal of Radiation Oncology Biology Physics, 2006

Introduction Supratentorial primitive neuroectodermal tumors (SPNET) are rare tumors accounting f... more Introduction Supratentorial primitive neuroectodermal tumors (SPNET) are rare tumors accounting for only 2.5% of childhood brain tumors. The purpose of this study was to describe the range of treatment regimens used to treat pediatric SPNET in Canada and to identify prognostic factors for overall survival in this population. Methods This study was a retrospective clinical analysis of SPNET patients treated over the last 10 years in Canada. A questionnaire was developed and distributed to all institutions in Canada who treat pediatric patients. Data were collected for patients <19 years of age who were diagnosed and treated for SPNET between 1995 and 2005.

Journal of Neuro-oncology, 2010

After successfully using cisplatin (30 mg/m 2 / day) and etoposide (150 mg/m 2 /day) in ten three... more After successfully using cisplatin (30 mg/m 2 / day) and etoposide (150 mg/m 2 /day) in ten three-day courses for progressive low-grade gliomas, a subsequent protocol reduced the daily doses of cisplatin (to 25 mg) and etoposide (to 100 mg), with the objective of achieving the same response and three-year PFS rates with lower neurotoxicity and myelotoxicity. We treated 37 patients (median age 6 years); 23 had optochiasmatic tumours and nine were metastatic cases. Diagnoses were clinical in 13 cases and histological in 24, and comprised: pilocytic astrocytoma (17), ganglioglioma (3), pilomyxoid astrocytoma (2), and fibrillary astrocytoma (2). Treatment was prompted by radiological evidence of progression and/or clinical deterioration a median 18 months after the first diagnosis. After initial MRI staging, neurological and clinical examinations were performed before each chemotherapy cycle, with MRI after the first three courses and every three months thereafter. After a median 48 months, a volume reduction was appreciable in 24 cases (65%) and response was maximum 12 months after starting treatment. The three-year EFS and OS rates were 65 and 97%, respectively. Clinical, neurological, or functional improvements were seen in 26/37 cases. No children had a WBC nadir below 2,000/mm 3 . Audiological toxicity caused damage in 4/34 cases. The previous protocol had achieved volume reductions in 70% of cases, causing audiological damage (data updated) in 11/31 (P = 0.023), with three-year PFS and OS rates of 70 and 100%, respectively. Lower doses of cisplatin/etoposide are still effective in progressive lowgrade glioma, with less acute and persistent morbidity.

European Journal of Cancer, 2005

We retrospectively studied 26 consecutive adults treated for medulloblastoma using paediatric pro... more We retrospectively studied 26 consecutive adults treated for medulloblastoma using paediatric protocols. Between 1987 and 2003, patients P18 years old were given adjuvant chemotherapy consisting of one of two ÔpaediatricÕ regimens (depending on the time of presentation) and craniospinal local-boost radiotherapy: regimen A (n = 12), vincristine (VCR), intrathecal and/or intravenous methotrexate and conventional radiotherapy; or regimen B (n = 11) sequencing intensive doses of multiple agents followed by hyperfractionated accelerated radiotherapy (HART). A VCR-lomustine-based maintenance followed both regimens. Three additional patients received a tailored treatment due to their impaired neurological status after surgery. The median age at diagnosis was 26 years (range 18-41 years). With a median follow-up of 46 months, 5-year disease-free and overall survival rates were 65 ± 11% and 73 ± 10%, respectively, for the series as a whole. All patients who received regimen B (5 of whom had metastatic Chang M2-M3 disease) are alive with no evidence of disease at 39 months. Although the number of patients is limited, our data suggest that the sandwich sequential, moderately intensive chemotherapy in combination with HART is an effective treatment for medulloblastoma in adults, and this approach seems to overcome previously-recognised risk factors.