Subfrontal recurrence of medulloblastoma.

Twenty-nine patients received all or part of their therapy for medulloblastoma at our institution between 1983 and 1990. Review identified five patients (16%), with subfrontal recurrence, one of whom was initially treated by our staff. All five patients had undergone gross total tumor resection and irradiation of the entire neural axis. All subsequently died of uncontrolled tumor. Four recurrences, imaged with CT, had massive subfrontal deposits, from 4 em to 7 em in diameter (Fig. 1 ). A single case imaged with MR had a smaller, 2 em, recurrence (Fig. 2). Four of five patients had isolated subfrontal metastases; one had synchronous spinal -ecurrence. Review of radiotherapy portals clearly indicated that the subfrontal region was excluded from the therapy beam by eye blocks in four of five cases. The single recurrence after initial therapy at our hospital occurred despite inclusion of the subfrontal region in the therapy field.