Risk stratification treatment of medulloblastoma in children

doi:10.3877/cma.j.issn.2095-9141.2021.04.010

Abstract

Abstract:

Objective

To summarize the stratified treatment experience in children with medulloblastoma (MDB), and to explore the effect of risk classification of pediatric MDB on prognosis.

Methods

The clinical data of 32 children with MDB treated by stratification from January 2011 to December 2019 were analyzed retrospectively. According to the standard of risk classification, 32 children with MDB were divided into four groups: low risk, standard risk, high risk and extremely high risk. The relationship between tumor risk classification and prognosis was analyzed.

Results

The average follow-up time of 32 cases was 47 months (33-91 months). The 5-year overall survival rate (OS) and progression-free survival (PFS) were 57.3%±7.2% and 68.7%±8.6%, respectively. The OS and PFS in the low risk group were significantly higher than those in the high risk group, and were significantly higher in the standard risk group than in the extremely high risk group, and the differences have statistical significance (P<0.05).

Conclusion

Developing hierarchical treatment plans under the standard of risk classification criteria of MDB, it is beneficial to predict the prognosis, improve the survival rate and quality of life for MDB treatment.

Key words: Pediatric brain tumor, Medulloblastoma, Risk stratification, Stratified treatment

Lihua Chen, Kai Sun, Wenjin Chen, Yong Xia, Hongtian Zhang, Ruxiang Xu. Risk stratification treatment of medulloblastoma in children[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(04): 242-246.

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Figures/Tables 3

References 15

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危险度分级	例数	WNT型	SHH型	第3组	第4组
低危组	7	M0	无	无	M0,伴11号或17号染色体缺失
标危组	9	无	M0,TP53野生型，无MYCN基因扩增	M0,无MYCN基因扩增	M0,无11号染色体缺失
高危组	10	无	M+,TP53野生型/M0，MYCN基因扩增	无	M+
极高危组	6	无	TP53突变型	M+,伴MYCN基因扩增	无

危险度分级	例数	WNT型	SHH型	第3组	第4组
低危组	7	M0	无	无	M0,伴11号或17号染色体缺失
标危组	9	无	M0,TP53野生型，无MYCN基因扩增	M0,无MYCN基因扩增	M0,无11号染色体缺失
高危组	10	无	M+,TP53野生型/M0，MYCN基因扩增	无	M+
极高危组	6	无	TP53突变型	M+,伴MYCN基因扩增	无

风险分级	切除程度	放射治疗	化学治疗	预后
低危组	GTR/NTR	标准+局部调强	标准、6个疗程	好
标危组	GTR/NTR	标准+局部调强	标准、8个疗程	较好
高危组	STR/NTR	高剂量+局部调强	密集、10个疗程	较差
极高危组	STR/PTR	高剂量+局部调强	密集化学治疗+甲氨蝶呤联合、10个疗程	差

风险分级	切除程度	放射治疗	化学治疗	预后
低危组	GTR/NTR	标准+局部调强	标准、6个疗程	好
标危组	GTR/NTR	标准+局部调强	标准、8个疗程	较好
高危组	STR/NTR	高剂量+局部调强	密集、10个疗程	较差
极高危组	STR/PTR	高剂量+局部调强	密集化学治疗+甲氨蝶呤联合、10个疗程	差

风险分级	例数	5年OS	5年PFS
低危组	7	90.6%±13.5%	77.5%±8.7%
标危组	9	78.5%±9.8%	62.8%±8.2%
高危组	10	41.3%±9.6%^a	28.4%±7.4%^a
极高危组	6	21.6%±6.7%^b	16.8%±6.9%^b
F值		120.734	155.039
P值		<0.001	<0.001

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