Clinico-pathological and prognostic factors of Medulloblastoma - Tertiary care centre in India
PO-1149
Abstract
Clinico-pathological and prognostic factors of Medulloblastoma - Tertiary care centre in India
Authors: ADITYA KUMAR SINGLA1, RENU MADAN2, NARENDER KUMAR2, SHIKHA GOYAL2, MANJUL TRIPATHI3, KIRTI GUPTA4, DIVYA KHOSLA GUPTA2, RAKESH KAPOOR2
1PGIMER, CHANDIGARH, DEPARTMENT OF RADIOTHERAPY AND ONCOLOGY, CHANDIGARH, India; 2PGIMER, DEPARTMENT OF RADIOTHERAPY AND ONCOLOGY, CHANDIGARH, India; 3PGIMER, DEPARTMENT OF NEUROSURGERY, CHANDIGARH, India; 4PGIMER, DEPARTMENT OF PATHOLOGY, CHANDIGARH, India
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Purpose or Objective
Medulloblastoma
is the most common malignant brain tumor of children, with a peak incidence between 5-9 years of age. Standard treatment consists of maximum safe
resection followed by craniospinal irradiation (CSI) and chemotherapy. We
conducted this study to analyse the impact of various clinico-pathological and
treatment related parameters on outcome in medulloblastoma patients.
Material and Methods
Patients
records of medulloblastoma patients treated from January 2014 to December 2020
were retrieved. Survival curves were calculated using Kaplan- Meir method.
Impact of various factors on outcome including age, gender,
Karnofsky Performance Scale, extent of surgery,
adjuvant radiotherapy and chemotherapy was analysed using log rank test and cox
regression analysis. SPSS version 25.0 was used for statistical analysis.
Results
A total number of 115 patients were studied. Patient characteristics and treatment details have been
described in Table 1 and 2 respectively. RTOG
skin reactions (grade ≤2) were the most common acute reaction seen during RT
(n=85, 83.33%). Estimated five-year OS and PFS was 69.5% and 66.8% respectively. Factors
affecting OS and PFS were age, KPS, extent of resection and CSI (P < 0.05
for all). Chemotherapy significantly improved PFS (P=0.025) but not OS. Patients
aged > 16 years of age has better outcome as compared to younger patients.
TABLE
1
|
VARIABLE
|
N (%)
|
|
AGE
(Median =11, range 1-52years)
|
|
≤16 YEARS
|
73 (63.47%)
|
|
≥17YEARS
|
42 (36.52%)
|
|
SEX
|
|
MALE
|
78 (67.8%)
|
|
FEMALE
|
37 (32.2%)
|
|
SYMPTOMS
|
|
HEADACHE AND VOMITING
|
100(86.9%)
|
|
ATAXIA
|
26 (22.6%)
|
|
MOTOR DEFICIT
|
26 (22.6%)
|
|
KPS
|
|
≥70
|
93(80.8%)
|
|
≤60
|
22(19.1%)
|
|
LEPTOMENGEAL SPREAD
|
|
YES
|
15 (13.04%)
|
|
NO
|
100 (86.95%)
|
|
HISTOPATHOLOGY
|
|
CLASSIC
|
68 (59.1%)
|
|
DESMOPLASTIC
|
31 (26.9%)
|
|
ANAPLASTIC
|
16 (13.9%)
|
TABLE 2
|
VARIABLE
|
N
|
%
|
|
SURGERY
|
115
|
100
|
|
GTE
|
92
|
80%
|
|
NTE
|
14
|
12.2%
|
|
STE
|
7
|
6.1%
|
|
BIOPSY
|
2
|
1.7%
|
|
CSI (Median duration 48 days) -3DCRT
|
102
|
88.69%
|
|
LOW DOSE CSI
|
38
|
33.04%
|
|
STANDARD DOSE CSI
|
64
|
62.74%
|
|
CONCURRENT CHEMOTHERAPY
|
38
|
33.04%
|
|
ADJUVANT CHEMOTHERAPY
|
91
|
79.1%
|
Conclusion
Ongoing studies are risk
stratifying the patients and tailoring the treatment based on the molecular subgroups. Till
the results of these studies are available, maximum safe resection followed by CSI and
chemotherapy constitutes the standard of care in all medulloblastoma patients.