Mb-38adjuvant Radiotherapy Patterns of Care and Survival Implications for Medulloblastoma in Young Children
Year: 2016
Type: article
Study design: Observational Study
Abstract: PURPOSE: Postoperative radiotherapy (PORT) to the craniospinal axis is currently standard-of-care for pediatric medulloblastoma (MB), but is linked to long-term morbidity. PORT deferral has gained acceptance in children <3 years, though remains controversial in children age 3-8 years. We evaluated U.S. treatment patterns for PORT and survival implications in MB patients age 3-8. METHODS: Using the National Cancer Data Base, we identified patients age 3-8 with MB, stage M0-3, diagnosed in 2004-2012, who underwent resection and received adjuvant chemotherapy. Patients were designated “PORT-upfront” if they received PORT within 90 days of surgery or “PORT-deferred” if they did not. Clinicopathologic characteristics of the two cohorts were analyzed, and predictors of PORT deferral were identified using multivariable logistic regression. Overall survival (OS) was compared with log-rank tests and multivariable Cox regression. RESULTS: Among 816 patients, 123 (15.1%) had PORT-deferred, and 693 (84.9%) had PORT-upfront. 36.8% of 3-year-olds and 4.1% of 8-year-olds had PORT-deferred (P < 0.001). PORT-deferral decreased annually with age (OR: 0.63, 95%CI:0.55–0.71) and increased annually from 2004 to 2012 (OR: 1.15, 95%CI:1.07–1.24). With median follow-up of 4.0 years, OS was superior for patients with PORT-upfront versus PORT-deferred (5-year OS 82.0% vs. 63.4%, P < 0.001). On multivariable Cox regression, variables independently associated with worsened OS were PORT-deferral (HR: 2.00, 95%CI:1.18–3.40) and M1-3 disease (HR: 1.78, 95%CI:1.05–3.02). CONCLUSION: Using a national database, we found an increasing rate of PORT deferral for MB in children age 3 to 8 over time. The analysis suggests that PORT deferral is associated with worse survival in this age group.
Source: Neuro-Oncology
Language: English
Subfield: Genetics (clinical)
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2431621276