Late age-related outcomes of combined treatment of medulloblastomas of cerebellum in children
Objective – to analyse of late age-related outcomes of combined treatment of medulloblastomas (MB) of cerebellum in children.
Materials and methods. In our research the results of combined treatment of 297 children with MB of cerebellum of different age groups were analysed. Middle age of patients was (7.6 ± 2.1) years. 33 (11.1 %) patients were children of first 3 years old, 97 (32.6 %) – 3-7 years, 114 (38.5 %) – 7-11 years, 53 (17.8 %) – 12-18 years. In 247 (81.3 %) patients the initial place of growth of MB was a worm of cerebellum and in 34 (11.4 %) – hemispheres of cerebellum. The size of tumour was up to 3 cm in 49 (16.5 %) patients, 3-5 cm – in 230 (77.4 %), over 5 cm – in 18 (6 %). Surgical treatment was supplemented by shunt operations in 71 (25.5 %) children. Radiotherapy was conducted to 186 (66.9 %) children, chemotherapy – to 121 (45.4 %). During 30 days after operation died 31 (10.8 %) patients. A catamnesis from 1 month is 10 was analysed in 225 (84.6 %) children.
Results. In children of first 3 years old the T2 and T3a stages of MB according Chang were dominant (65.3 %), in children of 4-18 years old – T3a and T3b stages (70 %). T4 was in 18.1 % children of 0-3 years old and in 7.5 % children of 4-18 years old. A complete resection of MB was executed in 35 % patients, subtotal – in 52.8 %, partial or biopsy – in 12.1 %. Postoperative complications were in 49 (16.5 %) patients. For the children of 0-3 years old anaplastic (27.3 %) and «classic» forms of MB (42.4 %) prevailed, which associated with the worse prognosis. For children of 3-7 years «classic» MB prevailed (65 %); anaplastic MB was only at 17.5 % patients. Only 3-7 % children of 7-11 years had anaplastic MB. The frequency of metastases of MB in children of 0-3 years was 18.0 %, in patients of 4-18 years – 10-15 %. A median of survival in children of first 3 years was 12-18 months, depending on the volume of radio- and chemotherapy, for patients of 4-18 years – 24-36 months.
Conclusions. The analysis of the results of the combined treatment of MB of cerebellum for the children of the different age groups allowed the worst prognosis for the children of 0-3 years old, that is founding for the further study of the age-related outcomes of treatment of MB of cerebellum in children and requires the optimization of surgical tactics and combined therapy for the children of the different age groups.
Kann B, Park H, Lester-Coll N et al. Adjuvant radiation therapy patterns and survival implications for medulloblastoma in young children. Intern. J. Radiat. Oncol Biol Physics. 2016;96(2):S230-1. doi: 10.1016/j. ijrobp.2016.06.573.
Chang CH, Hausepian EM, Herbert C. An operative staging system and a megavoltage radiotherapeutic technique for cerebellar medulloblastoma. Radiol. 196 9;93(6):1351-9. doi: 10.1148/936.1351.
Ellison DW. Childhood medulloblastoma: novel approaches to the classification of a heterogeneous disease. Acta Neuropathol. 2010;120 (3):305-16. doi: 10.1007/s00401-010-0726-6.
Schreiber JE, Gurney JG, Palmer SL et al. Examination of risk factors for intellectual and academic outcomes following treatment for pediatric. Neuro Oncol. 2014;16(8):1129-36. doi: 10.1093/neuonc/nou006.
Lannering B, Rutkowski S, Doz F et al. Hyperfrac- tionated versus conventional radiotherapy followed by chemotherapy in standard-risk medulloblastoma: results from the randomized multicenter HIT-SIOP PNET 4 trial. J. Clin. Oncol. 2012;30(26):3187-93. doi: 10.1200/jco.2011.39.8719.
Ashley DM, Merchant TE, Strother D, Zhou T, Duff- ner P. Induction chemotherapy and conformal radiation therapy for very young children with nonmetastatic medulloblastoma: Children's Oncology Group Study P9934. J. Clin. Oncol. 2012;30(26):3181-6. doi: 10.1200/jco.2010.34.4341
Coluccia D, Figuereido C, Isik S et al. Medulloblastoma: Tumor biology and revelance to treatment and prognosis paradigm. Curr. Neurol. Neurosci Rep. 2016 May;16 (5):43. doi:10.1007/s11910-016-0644-7.
Northcott PA, Jones DTW, Kool M et al. Medullo- blastomics: the end of the begining. Nat. Rev. Cancer. 2012;12 (12):818-34. doi 10.1038/nrc3410
Louis D, Ohgaki H, Wiestler O et al. The 2007 WHO Classification of Tumours of the Central Nervous System. Acta Neuropathol. 2007;114(2):97-109. doi:10.10 07/s00401-007-0243-4
Louis D, Perry A, Reifenberger G et al. The 2016 WHO Classification of Tumours of the Central Nervous System: a summary. Acta Neuropathol. 2016;131(6):803- 20. doi 10.1007/s00401-016-1545-1.
Karnofsky DA, Abelmann WH, Craver LF, Burche- nal JH. The use of the nitrogen mustards in the palliative treatment of carcinoma. with particular reference to bronchogenic carcinoma. Cancer. 1948;1(4):634-56. doi: 10.1002/1097-0142 (194811) 1:4<634::aid-cncr2 820010410>3.0.co;2-l