Extent of resection and histopathology grading as a survival risk factor in a patient with medulloblastoma

Resi Prastikarunia; Muhammad Arifin Parenrengi; Pudji Lestari; Agus Turchan; Eko Agus Subagio; Irwanto

doi:10.15562/bmj.v12i1.4008

Extent of resection and histopathology grading as a survival risk factor in a patient with medulloblastoma

Resi Prastikarunia ,

Muhammad Arifin Parenrengi ,

Pudji Lestari ,

Agus Turchan ,

Eko Agus Subagio ,

Irwanto ,

pdf |
DOI: https://doi.org/10.15562/bmj.v12i1.4008 |
Published: 2023-01-25

Abstract

Background: Medulloblastoma is a common neoplasm in the pediatric population with a poor prognosis. Incomplete resection has been reported to be related to second-look surgery and subsequent more malignant clinical course, while certain histopathological is said to have a more favorable prognosis.

Methods: This study retrospectively analyzed data from patients with medulloblastoma who underwent tumor resection in our hospital between 2016 to 2020. Histopathologic information and the extent of resection were collected. Survival analysis was done with log-rank and Kaplan-Meier to determine the overall and progression-free survival.

Results: There were 42 patients with medulloblastoma with mean overall survival of 16.5 months and a mean progression-free survival of 12.43 months. Patient with subtotal resection has the longest mean overall survival and progression-free survival compared with others. Patient with classical medulloblastoma has the longest mean overall survival and progression-free survival compared to other types of histopathology.

Conclusion: The extent of resection and histopathology grading is statistically significantly related to the outcome of a patient with medulloblastoma

References

de Medeiros CB, Moxon-Emre I, Scantlebury N, Malkin D, Ramaswamy V, Decker A, et al. Medulloblastoma has a global impact on health related quality of life: Findings from an international cohort. Cancer Med. 2020;9(2):447.
Smoll NR. Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs). Cancer. 2012;118(5):1313–22.
Patel S, Bhatnagar A, Wear C, Osiro S, Gabriel A, Kimball D, et al. Are pediatric brain tumors on the rise in the USA? Significant incidence and survival findings from the SEER database analysis. Childs Nerv Syst. 2014;30(1):147–54.
Johnston DL, Keene D, Kostova M, Lafay-Cousin L, Fryer C, Scheinemann K, et al. Survival of children with medulloblastoma in Canada diagnosed between 1990 and 2009 inclusive. J Neurooncol. 2015;124(2):247–53.
Tandian D, Harlyjoy A, Nugroho SW, Ichwan S. Risk Factors Associated with Post-therapeutic Outcome for Medulloblastoma: An Experience from Indonesia. Asian J Neurosurg. 2021;16(3):494.
Kumar L, Deepa SFA, Moinca I, Suresh P, Naidu KVJR. Medulloblastoma: A common pediatric tumor: Prognostic factors and predictors of outcome. Asian J Neurosurg. 2015;10(1):50.
Nalita N, Ratanalert S, Kanjanapradit K, Chotsampancharoen T, Tunthanathip T. Survival and Prognostic Factors in Pediatric Patients with Medulloblastoma in Southern Thailand. J Pediatr Neurosci. 2018;13(2):150.
Thompson EM, Hielscher T, Bouffet E, Remke M, Luu B, Gururangan S, et al. Prognostic Value of Medulloblastoma Extent of Resection After Accounting for Molecular Subgroup: An Integrated Clinical and Molecular Analysis. Lancet Oncol. 2016;17(4):484.
Eid AM, Heabah NAEG. Medulloblastoma: clinicopathological parameters, risk stratification, and survival analysis of immunohistochemically validated molecular subgroups. J Egypt Natl Canc Inst. 2021;33(1).
Bouffet E. Management of high-risk medulloblastoma. Neurochirurgie. 2021;67(1):61–8.
Thompson EM, Bramall A, Herndon JE, Taylor MD, Ramaswamy V. The clinical importance of medulloblastoma extent of resection: a systematic review. J Neurooncol. 2018;139(3):523–39.
Albright AL, Wisoff JH, Zeltzer PM, Boyett JM, Rorke LB, Stanley P. Effects of medulloblastoma resections on outcome in children: A report from the children’s cancer group. Neurosurgery. 1996;38(2):265–71.
Urberuaga A, Navajas A, Burgos J, Pijoán JI. A review of clinical and histological features of Spanish paediatric medulloblastomas during the last 21 years. Child’s Nerv Syst. 2006;22(5):466–74.
Cavalli FMG, Remke M, Rampasek L, Peacock J, Shih DJH, Luu B, et al. Intertumoral Heterogeneity within Medulloblastoma Subgroups. Cancer Cell. 2017;31(6):737-754.e6.
Eberhart CG, Kepner JL, Goldthwaite PT, Kun LE, Duffner PK, Friedman HS, et al. Histopathologic grading of medulloblastomas: A Pediatric Oncology Group study. Cancer. 2002;94(2):552–60.
Liu Y, Xiao B, Li S, Liu J. Risk Factors for Survival in Patients With Medulloblastoma: A Systematic Review and Meta-Analysis. Front Oncol. 2022;12(March):4–6.
Abdelbaki MS, Boué DR, Finlay JL, Kieran MW. Desmoplastic nodular medulloblastoma in young children: A management dilemma. Neuro Oncol. 2018;20(8):1026–33.
Kool M, Korshunov A, Remke M, Jones DTW, Schlanstein M, Northcott PA, et al. Molecular subgroups of medulloblastoma: An international meta-analysis of transcriptome, genetic aberrations, and clinical data of WNT, SHH, Group 3, and Group 4 medulloblastomas. Acta Neuropathol. 2012;123(4):473–84.
Taylor MD, Northcott PA, Korshunov A, Remke M, Cho Y-J, Clifford SC, et al. Molecular subgroups of medulloblastoma: the current consensus. Acta Neuropathol. 2012;123(4):465–72.
Wang X, Dubuc AM, Ramaswamy V, Mack S, Gendoo DMA, Remke M, et al. Medulloblastoma subgroups remain stable across primary and metastatic compartments. Acta Neuropathol. 2015;129(3):449–57.
Packer RJ, Gajjar A, Vezina G, Rorke-Adams L, Burger PC, Robertson PL, et al. Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol. 2006;24(25):4202–8.
Paulino AC, Lobo M, Teh BS, Okcu MF, South M, Butler EB, et al. Ototoxicity after intensity-modulated radiation therapy and cisplatin-based chemotherapy in children with medulloblastoma. Int J Radiat Oncol Biol Phys. 2010;78(5):1445–50.
Yock TI, Yeap BY, Ebb DH, Weyman E, Eaton BR, Sherry NA, et al. Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: A phase 2 single-arm study. Lancet Oncol. 2016;17(3):287–98.
Mulhern RK, Palmer SL, Merchant TE, Wallace D, Kocak M, Brouwers P, et al. Neurocognitive consequences of risk-adapted therapy for childhood medulloblastoma. J Clin Oncol. 2005;23(24):5511–9.
Christopherson KM, Rotondo RL, Bradley JA, Pincus DW, Wynn TT, Fort JA, et al. Late toxicity following craniospinal radiation for early-stage medulloblastoma. Acta Oncol (Madr). 2014;53(4):471–80.
Liu X, Ding C, Tan W, Zhang A. Medulloblastoma: Molecular understanding, treatment evolution, and new developments. Pharmacol Ther. 2020;210:107516.

[1] de Medeiros CB, Moxon-Emre I, Scantlebury N, Malkin D, Ramaswamy V, Decker A, et al. Medulloblastoma has a global impact on health related quality of life: Findings from an international cohort. Cancer Med. 2020;9(2):447.

[2] Smoll NR. Relative survival of childhood and adult medulloblastomas and primitive neuroectodermal tumors (PNETs). Cancer. 2012;118(5):1313–22.

[3] Patel S, Bhatnagar A, Wear C, Osiro S, Gabriel A, Kimball D, et al. Are pediatric brain tumors on the rise in the USA? Significant incidence and survival findings from the SEER database analysis. Childs Nerv Syst. 2014;30(1):147–54.

[4] Johnston DL, Keene D, Kostova M, Lafay-Cousin L, Fryer C, Scheinemann K, et al. Survival of children with medulloblastoma in Canada diagnosed between 1990 and 2009 inclusive. J Neurooncol. 2015;124(2):247–53.

[5] Tandian D, Harlyjoy A, Nugroho SW, Ichwan S. Risk Factors Associated with Post-therapeutic Outcome for Medulloblastoma: An Experience from Indonesia. Asian J Neurosurg. 2021;16(3):494.

[6] Kumar L, Deepa SFA, Moinca I, Suresh P, Naidu KVJR. Medulloblastoma: A common pediatric tumor: Prognostic factors and predictors of outcome. Asian J Neurosurg. 2015;10(1):50.

[7] Nalita N, Ratanalert S, Kanjanapradit K, Chotsampancharoen T, Tunthanathip T. Survival and Prognostic Factors in Pediatric Patients with Medulloblastoma in Southern Thailand. J Pediatr Neurosci. 2018;13(2):150.

[8] Thompson EM, Hielscher T, Bouffet E, Remke M, Luu B, Gururangan S, et al. Prognostic Value of Medulloblastoma Extent of Resection After Accounting for Molecular Subgroup: An Integrated Clinical and Molecular Analysis. Lancet Oncol. 2016;17(4):484.

[9] Eid AM, Heabah NAEG. Medulloblastoma: clinicopathological parameters, risk stratification, and survival analysis of immunohistochemically validated molecular subgroups. J Egypt Natl Canc Inst. 2021;33(1).

[10] Bouffet E. Management of high-risk medulloblastoma. Neurochirurgie. 2021;67(1):61–8.

[11] Thompson EM, Bramall A, Herndon JE, Taylor MD, Ramaswamy V. The clinical importance of medulloblastoma extent of resection: a systematic review. J Neurooncol. 2018;139(3):523–39.

[12] Albright AL, Wisoff JH, Zeltzer PM, Boyett JM, Rorke LB, Stanley P. Effects of medulloblastoma resections on outcome in children: A report from the children’s cancer group. Neurosurgery. 1996;38(2):265–71.

[13] Urberuaga A, Navajas A, Burgos J, Pijoán JI. A review of clinical and histological features of Spanish paediatric medulloblastomas during the last 21 years. Child’s Nerv Syst. 2006;22(5):466–74.

[14] Cavalli FMG, Remke M, Rampasek L, Peacock J, Shih DJH, Luu B, et al. Intertumoral Heterogeneity within Medulloblastoma Subgroups. Cancer Cell. 2017;31(6):737-754.e6.

[15] Eberhart CG, Kepner JL, Goldthwaite PT, Kun LE, Duffner PK, Friedman HS, et al. Histopathologic grading of medulloblastomas: A Pediatric Oncology Group study. Cancer. 2002;94(2):552–60.

[16] Liu Y, Xiao B, Li S, Liu J. Risk Factors for Survival in Patients With Medulloblastoma: A Systematic Review and Meta-Analysis. Front Oncol. 2022;12(March):4–6.

[17] Abdelbaki MS, Boué DR, Finlay JL, Kieran MW. Desmoplastic nodular medulloblastoma in young children: A management dilemma. Neuro Oncol. 2018;20(8):1026–33.

[18] Kool M, Korshunov A, Remke M, Jones DTW, Schlanstein M, Northcott PA, et al. Molecular subgroups of medulloblastoma: An international meta-analysis of transcriptome, genetic aberrations, and clinical data of WNT, SHH, Group 3, and Group 4 medulloblastomas. Acta Neuropathol. 2012;123(4):473–84.

[19] Taylor MD, Northcott PA, Korshunov A, Remke M, Cho Y-J, Clifford SC, et al. Molecular subgroups of medulloblastoma: the current consensus. Acta Neuropathol. 2012;123(4):465–72.

[20] Wang X, Dubuc AM, Ramaswamy V, Mack S, Gendoo DMA, Remke M, et al. Medulloblastoma subgroups remain stable across primary and metastatic compartments. Acta Neuropathol. 2015;129(3):449–57.

[21] Packer RJ, Gajjar A, Vezina G, Rorke-Adams L, Burger PC, Robertson PL, et al. Phase III study of craniospinal radiation therapy followed by adjuvant chemotherapy for newly diagnosed average-risk medulloblastoma. J Clin Oncol. 2006;24(25):4202–8.

[22] Paulino AC, Lobo M, Teh BS, Okcu MF, South M, Butler EB, et al. Ototoxicity after intensity-modulated radiation therapy and cisplatin-based chemotherapy in children with medulloblastoma. Int J Radiat Oncol Biol Phys. 2010;78(5):1445–50.

[23] Yock TI, Yeap BY, Ebb DH, Weyman E, Eaton BR, Sherry NA, et al. Long-term toxic effects of proton radiotherapy for paediatric medulloblastoma: A phase 2 single-arm study. Lancet Oncol. 2016;17(3):287–98.

[24] Mulhern RK, Palmer SL, Merchant TE, Wallace D, Kocak M, Brouwers P, et al. Neurocognitive consequences of risk-adapted therapy for childhood medulloblastoma. J Clin Oncol. 2005;23(24):5511–9.

[25] Christopherson KM, Rotondo RL, Bradley JA, Pincus DW, Wynn TT, Fort JA, et al. Late toxicity following craniospinal radiation for early-stage medulloblastoma. Acta Oncol (Madr). 2014;53(4):471–80.

[26] Liu X, Ding C, Tan W, Zhang A. Medulloblastoma: Molecular understanding, treatment evolution, and new developments. Pharmacol Ther. 2020;210:107516.

Extent of resection and histopathology grading as a survival risk factor in a patient with medulloblastoma

Abstract

References

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