Paula Sedano1, Carmen González-San Segundo1, Lourdes De Ingunza1, Pedro Cuesta-Álvaro2, Marta Pérez-Somarriba3, Francisco Diaz-Gutiérrez1, Carmen Garrido Colino4, Alvaro Lassaletta5. 1. Radiation Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 2. Computing Services, Research Support, Complutense University of Madrid, Madrid, Spain. 3. Department of Pediatric Oncology, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain. 4. Pediatric Oncology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 5. Department of Pediatric Oncology, Hospital Infantil Universitario Niño Jesús, Avenida Menéndez Pelayo, 65, 28009, Madrid, Spain. lassaalvaro@yahoo.com.
Abstract
Medulloblastoma (MB) is a malignant embryonal tumor that develops especially in childhood, with overall survival (OS) at 5 years of up to 70%. The objective of this study is to analyze treatment delivery variables in a retrospective cohort and evaluate the impact of these treatment quality parameters on survival. From 2000 to 2018, 40 pediatric patients with medulloblastoma, treated according to current international protocols, were retrospectively analyzed. Treatment delivery quality indicators were analyzed including the extent of surgery, radiotherapy (RT) parameters, and chemotherapy variables, related with time and dose-intensity deviations. With a median follow-up of 74 months (range, 6-195), OS at 5 years was 74 ± 7%, 81 ± 8% for standard-risk, and 55 ± 16% for high-risk patients (p = 0.090). Disease-free survival at 5 years was not significantly affected by extent of surgery (p = 0.428) and RT-related variables such as surgery-RT interval (p = 0.776) neither RT duration (p = 0.172) or maintenance chemotherapy compliance (p = 0.634). Multivariate analysis identified risk groups predictive of worse DFS (p = 0.032) and leptomeningeal dissemination associated with inferior OS (p = 0.029). Conclusion: Treatment delivery optimization has improved survival rates of patients with MB. Despite this, in our study, we have not established a clear influence of the considered radiotherapy and chemotherapy treatment quality parameters on outcomes. What is Known: • Improvement in treatment modalities during the last decades has reached a 5-year OS of up to 70% in these patients. • Extent of resection and radiotherapy parameters such as interval between surgery-radiotherapy and radiotherapy duration has been described as probable survival prognostic factors. What is New: • Differences in medulloblastoma survival rates between prospective studies and retrospective series. • The impact on survival of the three main treatment variables, surgery, radiotherapy and chemotherapy, susceptible to improvement.
Medulloblastoma (MB) is a malignant embryonal tumor that develops especially in childhood, with overall survival (OS) at 5 years of up to 70%. The objective of this study is to analyze treatment delivery variables in a retrospective cohort and evaluate the impact of these treatment quality parameters on survival. From 2000 to 2018, 40 pediatric patients with medulloblastoma, treated according to current international protocols, were retrospectively analyzed. Treatment delivery quality indicators were analyzed including the extent of surgery, radiotherapy (RT) parameters, and chemotherapy variables, related with time and dose-intensity deviations. With a median follow-up of 74 months (range, 6-195), OS at 5 years was 74 ± 7%, 81 ± 8% for standard-risk, and 55 ± 16% for high-risk patients (p = 0.090). Disease-free survival at 5 years was not significantly affected by extent of surgery (p = 0.428) and RT-related variables such as surgery-RT interval (p = 0.776) neither RT duration (p = 0.172) or maintenance chemotherapy compliance (p = 0.634). Multivariate analysis identified risk groups predictive of worse DFS (p = 0.032) and leptomeningeal dissemination associated with inferior OS (p = 0.029). Conclusion: Treatment delivery optimization has improved survival rates of patients with MB. Despite this, in our study, we have not established a clear influence of the considered radiotherapy and chemotherapy treatment quality parameters on outcomes. What is Known: • Improvement in treatment modalities during the last decades has reached a 5-year OS of up to 70% in these patients. • Extent of resection and radiotherapy parameters such as interval between surgery-radiotherapy and radiotherapy duration has been described as probable survival prognostic factors. What is New: • Differences in medulloblastoma survival rates between prospective studies and retrospective series. • The impact on survival of the three main treatment variables, surgery, radiotherapy and chemotherapy, susceptible to improvement.
Authors: Einar Stensvold; Tor Åge Myklebust; Johan Cappelen; Bernt J Due-Tønnessen; Paulina Due-Tønnessen; Aleksandra Kepka; Tom Børge Johannesen; Bård Krossnes; Tryggve Lundar; Snezana Maric; Hrvoje Miletic; Viggo Moholdt; Kristin Smistad Myrmel; Terje Nordberg; Jana Rydland; Tore Stokland; Kristin Solem; Ole Solheim; Ingrid Torsvik; Gry C Wikran; Bernward Zeller; Finn Wesenberg; Anne Grete Bechensteen; Petter Brandal Journal: Pediatr Blood Cancer Date: 2019-07-01 Impact factor: 3.167
Authors: J O del Charco; T W Bolek; W M McCollough; B L Maria; A Kedar; R C Braylan; J P Mickle; J M Buatti; N P Mendenhall; R B Marcus Journal: Int J Radiat Oncol Biol Phys Date: 1998-08-01 Impact factor: 7.038