Role of neoadjuvant chemotherapy in metastatic medulloblastoma: a comparative study in 92 children.

Abstract:

BACKGROUND:Previous pilot studies have shown the feasibility of preoperative chemotherapy in patients with medulloblastoma, but benefits and risks compared with initial surgery have not been assessed. METHODS:Two therapeutic strategies were retrospectively compared in 92 patients with metastatic medulloblastoma treated at Gustave Roussy between 2002 and 2015: surgery at diagnosis (n = 54, group A) and surgery delayed after carboplatin and etoposide-based neoadjuvant therapy (n = 38, group B). Treatment strategies were similar in both groups. RESULTS:The rate of complete tumor excision was significantly higher in group B than in group A (93.3% vs 57.4%, P = 0.0013). Postoperative complications, chemotherapy-associated side effects, and local progressions were not increased in group B. Neoadjuvant chemotherapy led to a decrease in the primary tumor size in all patients; meanwhile 4/38 patients experienced a distant progression. The histological review of 19 matched tumor pairs (before and after chemotherapy) showed that proliferation was reduced and histological diagnosis feasible and accurate even after neoadjuvant chemotherapy. The 5-year progression-free and overall survival rates were comparable between groups. Comparison of the longitudinal neuropsychological data showed that intellectual outcome tended to be better in group B (the mean predicted intellectual quotient value was 6 points higher throughout the follow-up). CONCLUSION:Preoperative chemotherapy is a safe and efficient strategy for metastatic medulloblastoma. It increases the rate of complete tumor excision and may improve the neuropsychological outcome without jeopardizing survival. KEY POINTS:1. Preoperative chemotherapy increases the rate of complete tumor removal.2. No additional risk (toxic or disease progression) is linked to the delayed surgery.3. Preoperative chemotherapy could have a positive impact on the neuropsychological outcome of patients.

journal_name

Neuro Oncol

journal_title

Neuro-oncology

authors

Guerrini-Rousseau L,Abbas R,Huybrechts S,Kieffer-Renaux V,Puget S,Andreiuolo F,Beccaria K,Blauwblomme T,Bolle S,Dhermain F,Longaud Valès A,Roujeau T,Sainte-Rose C,Tauziede-Espariat A,Varlet P,Zerah M,Valteau-Couanet D,D

doi

10.1093/neuonc/noaa083

subject

Has Abstract

pub_date

2020-11-26 00:00:00

pages

1686-1695

issue

11

eissn

1522-8517

issn

1523-5866

pii

5817932

journal_volume

22

pub_type

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