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Medulloblastoma in children 0-3 years old: forty years' experience in slovenia
1Department of Neurology, University Children Hospital Medical Center, Zaloska, Slovenia.
Insights
For young children with medulloblastoma (MB), preradiation chemotherapy with high-dose cyclophosphamide, etoposide, and vincristine (HDCy) combined with reduced radiation doses shows promising long-term survival outcomes.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Medical History
Background:
- Medulloblastoma (MB) is a common malignant brain tumor in young children.
- Treatment strategies for MB have evolved significantly over time, impacting survival rates.
- Early treatment protocols had high mortality rates, necessitating the exploration of alternative approaches.
Purpose of the Study:
- To evaluate the long-term outcomes of medulloblastoma treatment in children aged 0-3 years.
- To compare survival rates and developmental outcomes between different treatment eras and modalities.
- To assess the efficacy and safety of preradiation chemotherapy with high-dose cyclophosphamide, etoposide, and vincristine (HDCy) and reduced radiation doses.
Main Methods:
- Retrospective analysis of 21 children (0-3 years) diagnosed with MB between 1960 and 1996.
- Categorization of patients based on treatment received: no treatment, postoperative radiotherapy (RT), iodine-125 interstitial therapy (IT), and preradiation chemotherapy (Cht) with HDCy.
- Comparison of survival rates, including early mortality and long-term survival, and assessment of developmental outcomes in survivors.
Main Results:
- Of 14 children treated before 1984, 12 died within one year; one survived 42 years with a secondary hypopharyngeal cancer, and one had a normal outcome.
- Among 7 children treated from 1986-1996 with preradiation Cht (5 with HDCy), 3 with disseminated disease died.
- Four children achieved long-term survival, with two treated with reduced RT doses exhibiting normal development.
Conclusions:
- Preradiation chemotherapy with HDCy followed by reduced doses of RT appears to be a viable and effective treatment strategy for young children with medulloblastoma.
- This approach may improve long-term survival and reduce treatment-related toxicities compared to older protocols.
- Further research into optimized chemotherapy and radiotherapy regimens is warranted for pediatric medulloblastoma.
Abstract:
Twenty-one children 0-3 years with MB were admitted 1960-1996, of 14 before treated 1984, 3 had no treatment, 5 had postoperative RT, one had radioactive gold IT. Seven treated 1986-1996 had preradiation Cht, 5 with HDCy. Of the 14 treated before 1984, 12 died within 1 year, one after 42 years in hypopharynx cancer, one is alive, of normal height and working. Of the 7 treated 1986-1996, 3 with disseminated disease died. Four are longtime survivors, 2 treated with reduced doses of RT of normal development. Preradiation Cht with HDCy and reduced doses of RT seems to be a reasonable approach.
