Real-world data for pediatric medulloblastoma: can we improve outcomes?
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ORIGINAL ARTICLE
Real-world data for pediatric medulloblastoma: can we improve outcomes? Paula Sedano 1 & Carmen González-San Segundo 1 & Lourdes De Ingunza 1 & Pedro Cuesta-Álvaro 2 & Marta Pérez-Somarriba 3 & Francisco Diaz-Gutiérrez 1 & Carmen Garrido Colino 4 & Alvaro Lassaletta 3 Received: 27 March 2020 / Revised: 8 June 2020 / Accepted: 17 June 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
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 doseintensity deviations. With a median follow-up of 74 months (range, 6–195), OS at 5 years was 74 ± 7%, 81 ± 8% for standardrisk, 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.
Keywords Medulloblastoma . Surgery . Radiotherapy . Survival . Treatment quality . Children
Communicated by Peter de Winter * Alvaro Lassaletta [email protected] Paula Sedano [email protected] Carmen González-San Segundo [email protected] Lourdes De Ingunza [email protected] Pedro Cuesta-Álvaro [email protected]
Marta Pérez-Somarriba [email protected] Francisco Diaz-Gutiérrez [email protected] Carmen Garrido Colino [email protected] Extended author information available on the last page of the article
Eur J Pediatr
Abbreviations CG Children’s Oncology Group ChT Chemotherapy CI C
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