Dados do Trabalho

Título

Outcomes, prognostic factors, and sequelae associated with multimodal treatment in pediatric patients with medulloblastoma treated in the last 20 years at a single institution.

Introdução

Medulloblastoma is an embryonic tumor that affects a large number of pediatric patients with central nervous system tumors. Multimodal treatment combining surgery, followed by radiotherapy and chemotherapy has been standard for many years. The prognosis depends on factors related to both the tumor and technical parameters. Late sequelae related to endocrine, ophthalmological, auditory and cognitive function may affect patients.

Objetivo

Evaluate the result of multidisciplinary treatment, prognostic factors and the development of related sequelae in children with medulloblastoma, comparing with literature data.

Método

Retrospective study of patients under the age of 21 years at diagnosis, who underwent craniospinal radiotherapy treatment (RT-CSP) after tumor resection with confirmed diagnosis as medulloblastoma between 2000 and 2021. The study was designed to assess global survival, local control and locoregional. Prognostic factors were analyzed with the log rank test, in the univariate analysis. Late sequelae were graded according to CTC version 4.0. Values ​​of p<0.05 were considered significant.

Resultados

During the period, 49 patients < 21 years old met the inclusion criteria. The average age was 10 years (ranging from 3 to 21 years), with 57% male. Classic medulloblastoma (88%) was the most common histological type. Radical surgery was possible in 67%. Stratifying the sample by risk group, 47% were considered high risk. The mean dose of RT-CSP and boost in the posterior fossa was 36 Gy (23.4-45 Gy) and 54 Gy (50-55.8 Gy), respectively. The 2D and 3D/IMRT was used in 59 and 41%. The median follow-up was 40 months (3-192 months). There were 31 deaths and 9 failures during follow-up. The 5-year global, local (posterior fossa) and locoregional (fossa and medulla) control survival was 68%, 90% and 76.2%. Regarding prognostic factors related to OS, tumors classified as high risk (p=0.008), subtotal resection (p=0.001), and anaplastic histology (p=0.02) were statistically associated with worse survival. Late toxicity was observed in 19 (38.7%). IMRT/3DRT were statistically associated with a lower risk of developing any late toxicity (p=0.001).

Conclusão

RT – CSP with adequate dose resulted in an overall survival rate, local and regional control comparable to the literature. The incorporation of contemporary techniques over time has been associated with reduced toxicity.
The worst prognosis of high-risk tumors, may be useful in the discussion of treatment intensification to better maximize results.

Palavras-chave

Medulloblastoma, Radiotherapy, Late toxicity