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Postoperative radiotherapy of childhood medulloblastomas
1Department of Radiotherapy, Haynal Imre Medical University, National Institute of Oncology, Budapest, Hungary.
Insights
Radiotherapy effectively treats pediatric medulloblastoma, with survival rates improving for patients without metastases and in lower-risk groups. Tumor size and M stage significantly impact survival outcomes in children receiving radiation therapy.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-oncology
Background:
- Medulloblastoma is a common malignant brain tumor in children.
- Radiotherapy is a key component of multimodal treatment for medulloblastoma.
- Optimizing radiotherapy protocols is crucial for improving survival and reducing long-term side effects.
Purpose of the Study:
- To review the results of radiotherapy in treating pediatric medulloblastoma.
- To analyze factors influencing survival in pediatric medulloblastoma patients treated with radiotherapy.
Main Methods:
- Retrospective review of 66 pediatric medulloblastoma patients treated between 1986 and 1998.
- Patients received whole-brain and spinal cord irradiation with a posterior fossa boost.
- Dose stratification based on risk groups: 36 Gy for high-risk, 30 Gy for low-risk patients.
Main Results:
- Surgical radicality did not significantly impact survival.
- Increased tumor size significantly decreased survival chances (p = 0.03).
- Presence of metastases significantly worsened survival (81.5% vs. 66.7%, p = 0.02).
- Five-year survival was 80% in the low-risk group versus 67.4% in the high-risk group (p = 0.04).
- Tumor stage, patient age, risk group, and M stage were essential for predicting life expectancy.
Conclusions:
- Radiotherapy plays a vital role in medulloblastoma treatment for pediatric patients.
- Tumor size, M stage, and risk stratification are critical prognostic factors.
- Metastatic disease significantly reduces survival rates, highlighting the importance of early detection and treatment.
Abstract:
The purpose of this work is to review the result of radiotherapy in the treatment of medulloblastoma in pediatric patients. Between 1986 and 1998, 66 children (45 boys and 21 girls) received postoperative irradiation in our institute. Their mean age was 8.29 years. Irradiation was performed by linear accelerator, 36 Gy were applied in the high risk group (partial tumor resection, tumor cell positivity in the liquor, metastases within the central nervous system) and 30 Gy in the low risk group (total tumor resection, negative liquor cytology, no metastases within the central nervous system) on the entire cerebrum and spinal cord. This was followed in both groups by the application of 20-20 Gy boost irradiation on the posterior scala. Studying the survival it has been found that the surgical radicality did not significantly influence the survival chances of patients, however, with the increase in the tumor size the survival chance significantly decreases (p = 0.03). When predicting life expectancy, however, the stage of tumor, the age of patients, the risk group and the M stage yielded essential information. At the age of 8 years and less, the rate of survivors is 67.6%, for those over 8 years is 75.9% (p = 0.21), however the younger age was not significant. The appearance of metastases considerably deteriorates the chances of survival (from 81.5% to 66.7%, p = 0.02). In the low risk group of patients the 5-year survival is 80%, while in the high risk group it is significantly lower, 67.4% (p = 0.04).