Risk factors associated with post-therapeutic outcome for medulloblastoma: An experience from Indonesia

David Tandian; Alphadenti Harlyjoy; Setyo Nugroho; Syaiful Ichwan

doi:10.4103/ajns.AJNS_490_20

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2021; 16(03): 494-499
DOI: 10.4103/ajns.AJNS_490_20

Original Article

Risk factors associated with post-therapeutic outcome for medulloblastoma: An experience from Indonesia

David Tandian

Department of Neurosurgery, Faculty of Medicine, University of Indonesia, Jakarta

,

Alphadenti Harlyjoy

Department of Neurosurgery, Faculty of Medicine, University of Indonesia, Jakarta

,

Setyo Nugroho

Department of Neurosurgery, Faculty of Medicine, University of Indonesia, Jakarta

,

Syaiful Ichwan

Department of Neurosurgery, Faculty of Medicine, University of Indonesia, Jakarta

› Author Affiliations

Abstract

Context: The prognosis of medulloblastoma is better in patients who underwent complete treatment consisting of surgery, radiotherapy, and chemotherapy. However, the realization of such multidiscipline management is quite challenging in developing countries, including Indonesia. Until now, no study on the management of medulloblastoma has ever been conducted in Indonesia. Aims: The authors aimed to study the characteristics, management, and mortality outcome of medulloblastoma patients in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia. Subjects and Methods: This study was based on medical record and registry of 44 medulloblastoma patients who underwent tumor removal in Dr. Cipto Mangunkusumo National Referral Hospital, Jakarta, Indonesia, between 2011 and 2018. Statistical Analysis Used: Cox regression analysis was utilized to determine the relationship between patients' demography, tumor characteristics, and treatment, with mortality. Results: The incidence of mortality was 84.1% and median months' survival time (95% confidence interval [CI]) was 13 (8.67–17.32). Gross total removal (GTR) was performed in 43.2% of all tumor removal surgery. Only 50% of all patients completed radiotherapy, and 6.8% concluded multimodalities treatment (surgery, radiotherapy, and chemotherapy). Significant statistical association between age, gender, and extent of resection with mortality was identified (HR [95% CI] for age: 0.44 [0.22–0.88], gender: 0.001 [0.000–0.27; REF: female], and biopsy: 31.52 [1.09–910.56; REF: GTR]). Conclusions: The survival rate of medulloblastoma in Indonesia is inferior to that previously reported in other studies. There is no unusual characteristic contributing to neoteric risk factor. The authors surmise that insufficient multidisciplinary management for the disease, consisting of suboptimal tumor resection, the absence of risk stratification, and incomplete postsurgical treatment (radiotherapy and chemotherapy) resulted in such outcome.

Key-words:

Age - extent of resection - gender - medulloblastoma - mortality

Full Text

References

References
1 Ostrom QT, Cioffi G, Gittleman H, Patil N, Waite K, Kruchko C, et al. CBTRUS statistical report: Primary brain and other central nervous system tumors diagnosed in the United States in 2012-2016. Neuro Oncol 2019;21:v1-100.
2 Gupta N, Rutka JT. Brain tumors. In: Frim DM, Gupta N, editors. Pediatric Neurosurgery. USA: Landes; 2006. p. 95-109.
3 Johnston DL, Keene D, Kostova M, Strother D, Lafay-Cousin L, Fryer C, et al. Incidence of medulloblastoma in Canadian children. J Neurooncol 2014;120:575-9.
4 Juraschka K, Taylor MD. Medulloblastoma in the age of molecular subgroups: A review. J Neurosurg Pediatr 2019;24:353-63.
5 Northcott PA, Robinson GW, Kratz CP, Mabbott DJ, Pomeroy SL, Clifford SC, et al. Medulloblastoma. Nat Rev Dis Primers 2019;5:11.
6 Brandes AA, Bartolotti M, Marucci G, Ghimenton C, Agati R, Fioravanti A, et al. New perspectives in the treatment of adult medulloblastoma in the era of molecular oncology. Crit Rev Oncol Hematol 2015;94:348-59.
7 Gerber NU, Mynarek M, von Hoff K, Friedrich C, Resch A, Rutkowski S. Recent developments and current concepts in medulloblastoma. Cancer Treat Rev 2014;40:356-65.
8 Massimino M, Giangaspero F, Garre ML, Gandola L, Poggi G, Biassoni V, et al. Childhood Medulloblastoma in European Options and Recommendations for Cancer Diagnosis and Therapy. Vol. 1. Italy: OECI-EEIG; 2011.
9 Packer RJ, Zhou T, Holmes E, Vezina G, Gajjar A. Survival and secondary tumors in children with medulloblastoma receiving radiotherapy and adjuvant chemotherapy: Results of Children's Oncology Group Trial A9961. Neuro Oncol 2013;15:97-103.
10 Millard NE, De Braganca KC. Medulloblastoma. J Child Neurol 2016;31:1341-53.
11 United Nations: Department of Economics and Social Affairs. World Population Prospects 2019: Data Booklet. United Nations; 2019 [updated 2019 Jun; cited 2021 Feb 7]. Available from: https://population.un.org/wpp/Publications/Files/WPP2019_DataBooklet.pdf
12 Faried A, Pribadi MA, Sumargo S, Arifin MZ, Hernowo BS. Adult medulloblastoma: A rare case report and literature review. Surg Neurol Int 2016;7:S481-4.
13 Zulkarnaien B, Suharlim E, Susanto E, Gondhowiardjo SA. Multifocal recurrence of medulloblastoma: A long follow-up case study. Med J Indones 2020;29:93-9.
14 Nalita N, Ratanalert S, Kanjanapradit K, Chotsampancharoen T, Tunthanathip T. Survival and prognostic factors in pediatric patients with medulloblastoma in Southern Thailand. J Pediatr Neurosci 2018;13:150-7.
15 Müller W, Afra D, Schröder R, Slowik F, Wilcke O, Klug N. Medulloblastoma: Survey of factors possibly influencing the prognosis. Acta Neurochir (Wien) 1982;64:215-24.
16 Thompson EM, Hielscher T, Bouffet E, Remke M, Luu B, Gururangan S, et al. Prognostic value of medulloblastoma extent of resection after accounting for molecular subgroup: A retrospective integrated clinical and molecular analysis. Lancet Oncol 2016;17:484-95.
17 Jiang T, Zhang Y, Wang J, Du J, Ma Z, Li C, et al. Impact of tumor location and fourth ventricle infiltration in medulloblastoma. Acta Neurochir (Wien) 2016;158:1187-95.
18 Khalil J, Qing Z, Chuanying Z, Belkacémi Y, Benjaafar N, Mawei J. Twenty years experience in treating childhood medulloblastoma: Between the past and the present. Cancer Radiother 2019;23:179-87.
19 Narayan V, Sugur H, Jaiswal J, Arvinda HR, Arivazhagan A, Somanna S, et al. Medulloblastoma: Distinctive histo-molecular correlation with clinical profile, radiologic characteristics, and surgical outcome. Pediatr Neurosurg 2019;54:329-40.
20 Northcott PA, Robinson GW, Kratz CP, Mabbot DJ, Pomeroy SL, Clifford SC, et al. Medulloblastoma. Nat Rev Dis Primers 2019;5:11.
21 Guerrini-Rosseau L, Grill J, Dufour C. New stratification for early childhood medulloblastoma. Pediatr Med 2018;1:10.
22 Jenkin D, Shabanah MA, Shail EA, Gray A, Hassounah M, Khafaga Y, et al. Prognostic factors for medulloblastoma. Int J Radiat Oncol Biol Phys 2000;47:573-84.
23 Massimino M, Antoneli M, Gandola L, Miceli R, Pollo B, Biassoni V, et al. Histological variants of medulloblastoma are the most powerful clinical prognostic indicators. Pediatr Blood Cancer 2013;60:210-6.
24 Thompson EM, Bramall A, Herndon JE 2nd, Taylor MD, Ramaswamy V. The clinical importance of medulloblastoma extent of resection: A systematic review. J Neurooncol 2018;139:523-39.
25 Taylor MD. Medulloblastoma. In: Tonn JC, Westphal M, Rutka JT, Grossman SA, editors. Neuro-Oncology of CNS Tumors. German: Springer; 2006. p. 461-70.
26 Curran EK, Sainani KL, Le GM, Propp JM, Fisher PG. Gender affects survival for medulloblastoma only in older children and adults: A study from the surveillance epidemiology and end results registry. Pediatr Blood Cancer 2009;52:60-4.
27 Ciucci A, Meco D, De Stefano I, Travaglia D, Zanoni GF, Scambia GF, et al. Gender effect in experimental models of human medulloblastoma: Does the estrogen receptor β signaling play a role?. PLoS One. 2014 Jul 07;9(7):E101623. [doi: 10.1371/journal.pone.0101623].
28 Chan MY, Teo WY, Seow WT, Tan AM. Epidemiology, management and treatment outcome of medulloblastoma in Singapore. Ann Acad Med Singap 2007;36:314-8.
29 Kumar LP, Deepa SJ, Moinca I, Suresh P, Naidu K. Medulloblastoma: A common pediatric tumor: Prognostic factors and predictors of outome. Asian J Neurosurg 2015;10:50.
30 Albright AL, Wisoff JH, Zeltzer PM, Boyett JM, Rorke LB, Stanley P. Effects of medulloblastoma resections on outcome in children: A report from the Children's Cancer Group. Neurosurgery 1996;38:265-71.
31 Paterson E, Farr RF. Cerebellar medulloblastoma: Treatment by irradiation of the whole central nervous system. Acta radiol 1953;39:323-36.
32 Wang C, Yuan XJ, Jiang MW, Wang LF. Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma. J Neurosurg Pediatr 2015 Oct 09;17(1):1-8. [doi: 10.3171/2015.5.PEDS1573].
33 Gerber NU, Mynarek M, von Hoff K, Friedrich C, Resch A, Rutkowski S, et al. Recent developments and current concepts in medulloblastoma. Cancer Treat Rev 2014;40:356-65.