P16.04.B LONG TERM SURVIVAL AND TOXICITY OUTCOMES IN PEDIATRIC MEDULLOBLASTOMA: SINGLE CENTER EXPERIENCE
Bildiriler > Özet Bildiri
Yazarlar: Emine Serra KAMER, E Karaman, M S Acar, Yavuz ANACAK
Neuro-Oncology, , , Uluslararası, Özet Bildiri, Wos, cilt 26, ss v84-v84
DOI: 10.1093/neuonc/noae144.279
Özet
Abstract BACKGROUND Craniospinal radiotherapy(CSRT) is a crucial part of medulloblastoma treatment. Due to the diverse age range of patients and large treatment fields, long term toxicity results, as well as survival outcomes, must be evaluated. This study aims to assess treatment outcomes of CSRT in medulloblastoma patients at a single tertiary center, considering both long-term toxicity and survival. MATERIAL AND METHODS Pediatric medulloblastoma patients who underwent postoperative CSRT between 2000-2021 were included in the analysis. CSRT was planned with 3D CRT technique for all patiens. Craniospinal axis doses were 23,4 Gy for standard risk and 36 Gy for high risk group. Patients received posterior fossa or tumor bed boost according to their risk status. Clinical characteristics and survival outcomes were obtained from follow-up visits. For late toxicity analysis, patients with less than 2 years of follow-up were excluded. Assessments included educational issues, neurological deficits, hearing impairment, endocrinopathy, and growth impairment. RESULTS 120 cases (median age: 7 (2-17)) were analyzed with %61,7 being male. Gross total resection was achieved in 80,8% of cases. Most common histopathologic subtype was classical histology (76.7%). Forty-eight case (40%) was diagnosed in metastatic stage (M+) according to Chang’s classification. 52.5% of the cases were classified as high-risk group. Median follow-up was 64 months (4-252). 5- and 10-year overall survival was estimated to be 71.6% and 63.3% respectively. For the recurrence free survival; 5- and 10-year estimates were 68.5% and 61.6%. High risk group correlated adversely with overall survival (p<0.01). In follow-up, recurrence was detected in 41 cases (34.2%) with a median of 16 months (1-52). Recurrence sites included 22 cases in the primary site, 8 cases in the spinal region, and 11 cases in both region. Although a higher recurrence rate was observed in the high-risk group (41.2% vs. 26.3%), difference was not statistically significant. Seventy-five cases underwent late toxicity analysis, with 72% exhibiting at least one late toxicity. Educational issues were found in 36% of cases, permanent neurological deficit in 34.7%, hearing impairment in 32%, endocrine insufficiency in 40%, and growth impairment in 49.3%.Higher spinal dose (p:0,019), age ≤8 (p:0,011) and female sex (p:0,034) correlated with growth impairment. Endocrinopathy was significantly more prevalent in children over 12 years of age (p=0.032). During follow-up, three cases developed secondary malignancies: one meningioma and two papillary thyroid carcinomas. CONCLUSION CSRT is an effective treatment modality for pediatric medulloblastoma and must be meticulously administered in order to achieve acceptable survival outcomes and minimize late toxicity. Long-term follow-up is crucial for monitoring late adverse effects and recurrences in patients.