Prognostic factors for medulloblastoma.
ABSTRACT To evaluate prognostic factors for medulloblastoma.
One hundred and seventy-three consecutive patients with medulloblastoma, treated at King Faisal Specialist Hospital (KFSH) from 1988-1997, were reviewed. Eighty-four percent were children less than 15 years old. From 1988-1994, treatment was at the discretion of the investigator. From 1994-1998, patients entered a single-arm best practice protocol in which, in staged patients, the surgical intent was total resection, standard radiation treatment was defined, and adjuvant chemotherapy was given to a "high-risk" subset.
For 150 patients who completed surgical and radiation treatment, the 5-year survival rate was 58%, compared with 0% for 16 patients who were unable to start or complete radiation treatment. For staged patients, the 5-year survival was M0 + M1, 78% and M2 + M3, 21% (p < 0.0001). Other favorable significant prognostic factors were age >14 years and gross cystic/necrotic features in the primary tumor. The size of the primary tumor, the degree of hydrocephalus at diagnosis, the presence of residual tumor in the post-operative CT/MRI, and the functional status of the patient prior to radiation treatment were not significant factors.
Stage M0 + M1 was the most powerful favorable prognostic factor. In Saudi Arabia more patients present with advanced disseminated disease, 41% M2 + M3, than in the West, and this impacts adversely on overall survival. Total resection and standard radiation treatment were not sensitive prognostic factors in a treatment environment in which 78% of patients underwent at least 90% tumor resection and 60% received standard radiation treatment. In order to improve the proportion of patients able to complete radiation treatment, consideration should be given to limiting resection when the attainment of total resection is likely to be morbid, and to delaying rather than omitting radiation treatment in the patient severely compromised postoperatively.
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ABSTRACT: Thirty-eight consecutive children treated according to the HIT2000 and HIT91 studies for medulloblastoma who suffered 40 recurrence events were identified from a neuroradiological database. Relapse was associated with younger median age compared with all children treated on HIT2000. Eight patients relapsed with isolated local recurrence. There was no correlation with incomplete surgical removal or violation of the respective treatment protocol. Four patients were younger than 4 years at time of initial presentation and thus were not treated primarily with radiotherapy, suggesting that delayed radiotherapy might be a contributing factor. Meningeal dissemination was present in 32 events; 16 were located in the frontal region, 8 of which were isolated nodular frontal and frontobasal meningeal disease. Circumscribed meningeal recurrences were associated with better overall survival (OS) compared with diffuse, widespread recurrences. Isolated frontobasal meningeal relapses are a well-known phenomenon in medulloblastomas even years after treatment and have been correlated to an underdose of radiation in many literature reports. However, in our patients there was no correlation to possible treatment violations, indicating that inadequate radiation dose to the frontobasal region was unlikely to be a causative factor. Surgical technique varied due to the multicentric nature of our study, so position during surgery was not recognized as a predisposing factor for frontobasal recurrence.Journal of Neuro-Oncology 11/2010; 103(3):705-11. · 3.12 Impact Factor
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ABSTRACT: Tumor seeding is a strong negative prognostic factor for patients with medulloblastoma. Because Chang's M staging is based primarily on CT and myelographic findings and might be contradictory to the direction of normal cerebrospinal fluid (CSF) flow, seeding patterns and appropriate staging of medulloblastoma need to be revisited in patients diagnosed in the MRI era. We retrospectively reviewed the clinical and radiological data of 86 patients with a diagnosis of medulloblastoma who were treated in the MRI era. The presence of seeding in each subarachnoid space compartment and the patterns of seeding were analyzed in correlation with patient survival data. Thirty-four patients had gross seeding on perioperative MRI. Thirty-two patients had seeding in the spinal compartment. Sixteen and 12 patients had seeding in the infratentorial and supratentorial compartments, respectively. There was an apparent hierarchy of seeding (ie, from seeding in the spinal compartment up to the supratentorial compartment). Patients with seeding in the spinal compartment had longer progression-free survival (P = .038) and a tendency toward better overall survival (P = .053) compared with patients with seeding in intracranial compartments. We modified Chang's M staging based on the CSF flow and termed this approach "CSF M staging." CSF M staging for medulloblastoma, in which intracranial seeding occupies a higher rank than spinal seeding, was a better predictor of patient prognosis. This modified staging method may be applied to metastatic staging of brain tumors located in the fourth ventricle.Neuro-Oncology 03/2011; 13(3):334-44. · 6.18 Impact Factor
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ABSTRACT: Identifying prognostic factors that influence outcome is a key point in pediatric oncology, as it enables risk stratification and helps us to fine-tune risk-adapted treatments, thereby hopefully improving the chances of survival for high-risk patients, and minimizing the burden of treatment for those whose outlook is good. Along with other clinical and biological variables, tumor size at onset has been identified as a crucial variable in several pediatric malignancies, and in soft-tissue sarcomas in particular. This review provides a critical reappraisal of the prognostic role of tumor size in pediatric soft-tissue sarcomas.Future Oncology 12/2009; 5(10):1605-13. · 3.20 Impact Factor