Risk-Adapted Treatment Strategies with Pre-Irradiation Chemotherapy in Pediatric Medulloblastoma: Outcomes from the Polish Pediatric Neuro-Oncology Group
Marta Perek-Polnik,
Anne Cochrane,
Jinli Wang,
Marzanna Chojnacka,
Monika Drogosiewicz,
Iwona Filipek,
Ewa Swieszkowska,
Magdalena Tarasinska,
Wiesława Grajkowska,
Joanna Trubicka,
Paweł Kowalczyk,
Bożenna Dembowska-Bagińskai,
Mohamed S. Abdelbaki
Affiliations
Marta Perek-Polnik
Department of Oncology, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Anne Cochrane
Division of Hematology and Oncology, Department of Pediatrics, School of Medicine, Washington University, St. Louis, MO 63110, USA
Jinli Wang
Center for Biostatistics and Data Science, Washington University School of Medicine, St. Louis, MO 63110, USA
Marzanna Chojnacka
Maria Sklodowska-Curie National Research Institute of Oncology, Pediatric Radiotherapy Centre, 00-001 Warsaw, Poland
Monika Drogosiewicz
Department of Oncology, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Iwona Filipek
Department of Oncology, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Ewa Swieszkowska
Department of Oncology, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Magdalena Tarasinska
Department of Oncology, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Wiesława Grajkowska
Department of Pathology, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Joanna Trubicka
Department of Pathology, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Paweł Kowalczyk
Department of Neurosurgery, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Bożenna Dembowska-Bagińskai
Department of Oncology, Children’s Memorial Health Institute, 01-211 Warsaw, Poland
Mohamed S. Abdelbaki
Division of Hematology and Oncology, Department of Pediatrics, School of Medicine, Washington University, St. Louis, MO 63110, USA
Craniospinal irradiation (CSI) has been a major component of the standard of care treatment backbone for childhood medulloblastoma. However, chemotherapy regimens have varied based on protocol, patient age, and molecular subtyping. In one of the largest studies to date, we analyzed treatment outcomes in children with newly-diagnosed medulloblastoma treated with pre-irradiation chemotherapy followed by risk-adapted radiotherapy and maintenance chemotherapy. A total of 153 patients from the Polish Pediatric Neuro-Oncology Group were included in the analysis. The median age at diagnosis was 8.0 years, and median follow-up time was 6.4 years. Sixty-seven patients were classified as standard-risk and eighty-six as high-risk. Overall survival (OS) and event-free survival (EFS) for standard-risk patients at 5 years (±standard error) were 87 ± 4.3% and 84 ± 4.6%, respectively, while 5-year OS and EFS for high-risk patients were 81 ± 4.3% and 79 ± 4.5%, respectively. Only one patient had disease progression prior to radiotherapy. This study demonstrates promising survival outcomes in patients treated with pre-irradiation chemotherapy followed by risk-adapted CSI and adjuvant chemotherapy. Such an approach may be useful in cases where the initiation of radiotherapy may need to be delayed, a common occurrence in many institutions globally.
