Outcomes of Infants and Young Children With Relapsed Medulloblastoma After Initial Craniospinal Irradiation-Sparing Approaches: An International Cohort Study.

Document Type

Article

Publication Date

4-1-2023

Identifier

DOI: 10.1200/JCO.21.02968

Abstract

Purpose: Infant and young childhood medulloblastoma (iMB) is usually treated without craniospinal irradiation (CSI) to avoid neurocognitive late effects. Unfortunately, many children relapse. The purpose of this study was to assess salvage strategies and prognostic features of patients with iMB who relapse after CSI-sparing therapy.

Methods: We assembled a large international cohort of 380 patients with relapsed iMB, age younger than 6 years, and initially treated without CSI. Univariable and multivariable Cox models of postrelapse survival (PRS) were conducted for those treated with curative intent using propensity score analyses to account for confounding factors.

Results: The 3-year PRS, for 294 patients treated with curative intent, was 52.4% (95% CI, 46.4 to 58.3) with a median time to relapse from diagnosis of 11 months. Molecular subgrouping was available for 150 patients treated with curative intent, and 3-year PRS for sonic hedgehog (SHH), group 4, and group 3 were 60%, 84%, and 18% (P = .0187), respectively. In multivariable analysis, localized relapse (P = .0073), SHH molecular subgroup (P = .0103), CSI use after relapse (P = .0161), and age ≥ 36 months at initial diagnosis (P = .0494) were associated with improved survival. Most patients (73%) received salvage CSI, and although salvage chemotherapy was not significant in multivariable analysis, its use might be beneficial for a subset of children receiving salvage CSI < 35 Gy (P = .007).

Conclusion: A substantial proportion of patients with relapsed iMB are salvaged after initial CSI-sparing approaches. Patients with SHH subgroup, localized relapse, older age at initial diagnosis, and those receiving salvage CSI show improved PRS. Future prospective studies should investigate optimal CSI doses and the role of salvage chemotherapy in this population.

Journal Title

Journal of clinical oncology : official journal of the American Society of Clinical Oncology

Volume

41

Issue

10

First Page

1921

Last Page

1932

MeSH Keywords

Child; Humans; Infant; Child, Preschool; Medulloblastoma; Cohort Studies; Prospective Studies; Craniospinal Irradiation; Hedgehog Proteins; Neoplasm Recurrence, Local; Brain Neoplasms; Chronic Disease; Cerebellar Neoplasms

Keywords

Medulloblastoma; Cohort Studies; Prospective Studies; Craniospinal Irradiation; Hedgehog Proteins; Local Neoplasm Recurrence; Brain Neoplasms; Chronic Disease; Cerebellar Neoplasms

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