Abstract
PROPOSE: This is a retrospective study to review the outcome of pediatric patients with medulloblastoma (MBL) in the era of the modern therapy. PATIENTS AND METHODS: The medical charts of 36 cases of pediatric medulloblastoma (≤ 15 years) diagnosed between January 2001 and December 2011 were reviewed as regard the initial presentation, surgical, chemotherapy, and radiotherapy treatment. Survival analysis was done to determine the prognosis. RESULTS: The mean age of the group was a 7 ± 3 year, 8% (3 patients) were under the age of 3 years, and 21 patients (58%) were boys while 15 patients (42%) were girls. Headache, vomiting and ataxia were the most common presentations reported in 92%, 86%, and 64% of the patients respectively. Nineteen patients (53%) presented with M0 disease, 1 patient (3%) with M2 and 16 patients (44%) with M3. Fifteen patients (42%) were in the average-risk group, while 21 (58%) were in the high-risk group. Total resection of the tumor was done in 16 patients (44%), near total resection in 5 patients (14%), partial resection (biopsy) in 15 patients (42%). Twenty nine (81%) patients received initial first line chemotherapy and radiotherapy. At a mean follow up of 39 ± 29 months, 11 patients relapse, 4 patient underwent 2nd salvage surgery, 9 patients received second line chemotherapy, 3 patients received salvage radiotherapy. Three patients underwent salvage stem cell transplant. The 3 and 5 years disease free survival (DFS) and overall survival (OS) were 68 % & 53 % and 71% & 65% respectively. The only significant factors for OS were the age (≤3 Vs. >3 years P 0.005) and treatment per MBL protocol (P 0.021). On the other hand, age was also the significant factor for DFS (P 0.043). CONCLUSION: In the modern era, the use of combined modality treatment approach including safe surgical resection, neuroaxis radiotherapy and chemotherapy become the standard of care for treatment of Medulloblastoma, In our series, the age and the use of chemotherapy protocol emerging as significant factors for OS. Patients under 3 years had poor DFS and OS.