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- Title
Clinical Audit of Survival Outcomes and Prognostic Factors in Adolescents and Adults with Medulloblastoma.
- Authors
Patil, Roshankumar; Gupta, Tejpal; Maitre, Madan; Dasgupta, Archya; Sahay, Ayushi; Epari, Sridhar; Shirsat, Neelam; Chatterjee, Abhishek; Krishnatry, Rahul; Goda, Jayant Sastri; Moiyadi, Aliasgar; Patil, Vijay; Chinnaswamy, Girish; Bano, Nazia; Jalali, Rakesh
- Abstract
Purpose: Medulloblastomas, comprising 20%–25% of all primary brain tumors in children are much rarer in adulthood. Disease biology varies substantially across different age groups; however, owing to rarity, adults with medulloblastoma are traditionally treated using pediatric protocols. This is a retrospective audit of adolescent and adult medulloblastoma from a comprehensive cancer center. Methods: Data regarding demography, clinical presentation, imaging characteristics, histopathological features, molecular profiling, risk stratification, treatment details, and outcomes were retrieved from medical records. All time-to-event outcomes were analyzed using Kaplan–Meier method and compared with the log-rank test. Univariate and multivariate analysis of relevant prognostic factors was done with p value <0.05 being considered statistically significant. Results: A total of 162 patients ≥15 years of age with medulloblastoma were included. The median age was 25 years (range: 15–59 years) with leptomeningeal metastases seen in 31 (19%) patients at initial diagnosis. Following surgery, patients were treated with appropriate risk-stratified adjuvant therapy comprising of craniospinal irradiation plus boost with or without systemic chemotherapy. At a median follow-up of 50 months, 5-year Kaplan–Meier estimates of progression-free survival and overall survival were 53.5% and 59.5%, respectively. The addition of adjuvant systemic chemotherapy did not impact upon survival in standard-risk medulloblastoma. High-risk (HR) disease and anaplastic histology emerged as significant and independent predictors of poor survival on multivariate analysis. Conclusion: Medulloblastoma is a rare tumor in adolescents and adults with key differences in disease biology and resultant outcomes compared with the pediatric population. Contemporary management comprising maximal safe resection followed by appropriate risk-stratified adjuvant therapy provides acceptable survival outcomes.
- Subjects
BRAIN tumor diagnosis; AUDITING; SURVIVAL; STATISTICS; MULTIVARIATE analysis; RETROSPECTIVE studies; LOGROLLING (Medical procedure); TREATMENT effectiveness; BRAIN tumors; RISK assessment; KAPLAN-Meier estimator; ADULTS; ADOLESCENCE
- Publication
Journal of Adolescent & Young Adult Oncology, 2022, Vol 11, Issue 1, p68
- ISSN
2156-5333
- Publication type
Article
- DOI
10.1089/jayao.2021.0034