Predictors of Outcome in Pediatric Medulloblastoma
DOI:
https://doi.org/10.36283/ziun-pjmd14-4/061Abstract
Background: Medulloblastoma is the most common malignant brain tumor in children, arising in the cerebellum and representing a significant cause of morbidity and mortality in pediatric neuro-oncology. This study was don to evaluate clinical, radiological, and surgical predictors of short-term outcomes in pediatric patients diagnosed with medulloblastoma.
Methods: This retrospective, analytical, observational cohort study was conducted at the Pediatric Neurosurgery Department of the Children's Hospital and the Institute of Child Health, Multan, Pakistan, from January 2022 to March 2025. Data of children aged 1 to 12 years, histologically confirmed medulloblastoma, and underwent surgical intervention, were analyzed. Non-probability consecutive sampling technique was adopted. Short-term outcomes were documented in terms of mortality, and postoperative complications at 12-months. Data were analyzed using IBM SPSS Statistics version 26.0. Associations with 12-month mortality were assessed using chi-square or Fisher’s exact test.
Results: Among 60 children with medulloblastoma, 39 (65.0%) were male, and the mean age was 6.80±2.60 years. Gross-total resection was achieved in 32 (53.3%) cases. Postoperative complications included CSF leak and meningitis in 11 (18.3%) each. Classic histology was most common (63.3%). Radiotherapy and chemotherapy were administered in 88.3% and 85.0% of cases, respectively. Survival analysis estimated a 12-month overall survival of 90.0%. Mortality was significantly associated with younger age (p=0.008), short symptom duration (p=0.039), altered consciousness (p=0.005), metastasis (p=0.004), subtotal resection (p<0.001), meningitis (p=0.005), and anaplastic histology (p=0.008).
Conclusion: Relatively younger age, short symptom duration, altered consciousness at presentation, metastatic disease, subtotal resection, postoperative meningitis, and large cell/anaplastic histology were significantly contributors to 12-month mortality.
References
1.Fang FY, Rosenblum JS, Ho WS, Heiss JD. New Developments in the Pathogenesis, Therapeutic Targeting, and Treatment of Pediatric Medulloblastoma. Cancers (Basel). 2022;14(9):2285. doi: 10.3390/cancers14092285
2.Ostrom QT, Price M, Ryan K, Edelson J, Neff C, Cioffi G, et al. CBTRUS Statistical Report: Pediatric Brain Tumor Foundation Childhood and Adolescent Primary Brain and Other Central Nervous System Tumors Diagnosed in the United States in 2014-2018. Neuro Oncol. 2022;24(Suppl 3):iii1-iii38. doi: 10.1093/neuonc/noac161
3.Zafari P, Azarhomayoun A. Medulloblastoma Diagnosis and Treatment. IntechOpen 2024. doi: 10.5772/intechopen.1005443
4.Sirachainan N, Nuchprayoon I, Thanarattanakorn P, Pakakasama S, Lusawat A, Visudibhan A, et al. Outcome of medulloblastoma in children treated with reduced-dose radiation therapy plus adjuvant chemotherapy. J Clin Neurosci. 2011;18(4):515–519. doi: 10.1016/j.jocn.2010.08.012.
5.Cavalli FMG, Remke M, Rampasek L, Peacock J, Shih DJH, Luu B, et al. Intertumoral Heterogeneity within Medulloblastoma Subgroups. Cancer Cell. 2017;31(6):737-754.e6. doi: 10.1016/j.ccell.2017.05.005
6.Shi X, Sun X, Fan W, Dai X, Jiang M. Impact of radiation response on survival in pediatric medulloblastoma with residual or disseminated disease. Radiat Oncol. 2025;20(1):52. doi: 10.1186/s13014-025-02632-9
7.Pan Z, Bao J, Wei S. Advancing medulloblastoma therapy: strategies and survival insights. Clin Exp Med. 2025;25(1):119. doi: 10.1007/s10238-025-01648-5
8.Michalski JM, Janss AJ, Vezina LG, Smith KS, Billups CA, Burger PC, et al. Children's Oncology Group Phase III Trial of Reduced-Dose and Reduced-Volume Radiotherapy With Chemotherapy for Newly Diagnosed Average-Risk Medulloblastoma. J Clin Oncol. 2021;39(24):2685-2697. doi: 10.1200/JCO.20.02730
9.Ntenti C, Lallas K, Papazisis G. Clinical, Histological, and Molecular Prognostic Factors in Childhood Medulloblastoma: Where Do We Stand? Diagnostics (Basel). 2023;13(11):1915. doi: 10.3390/diagnostics13111915
10.Noiphithak R, Mektripop N, Thamwongskul C. Rapidly progressive medulloblastoma initially mimicking idiopathic intracranial hypertension and Chiari I malformation: A case report. Int J Surg Case Rep. 2021;85:106147. doi: 10.1016/j.ijscr.2021.106147
11.Ray S, Chaturvedi NK, Bhakat KK, Rizzino A, Mahapatra S. Subgroup-Specific Diagnostic, Prognostic, and Predictive Markers Influencing Pediatric Medulloblastoma Treatment. Diagnostics (Basel). 2021;12(1):61. doi: 10.3390/diagnostics12010061
12.Packer RJ, Sutton LN, Elterman R, Lange B, Goldwein J, Nicholson HS, et al. Outcome for children with medulloblastoma treated with radiation and cisplatin, CCNU, and vincristine chemotherapy. J Neurosurg. 1994;81(5):690-8. doi: 10.3171/jns.1994.81.5.0690
13.Ahn WK, Hahn SM, Yoon HI, Lee J, Park EK, Shim KW, et al. Long-term Outcomes of Protocol-Based Treatment for Newly Diagnosed Medulloblastoma. Cancer Res Treat. 2024;56(2):652-664. doi: 10.4143/crt.2023.865
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(2):150-157. doi: 10.4103/jpn.JPN_111_17
15.Zahid N, Enam SA, Mårtensson T, Azam I, Mushtaq N, Moochhala M, et al. Predictors of neurocognition outcomes in children and young people with primary brain tumor presenting to tertiary care hospitals of Karachi, Pakistan: a prospective cohort study. Childs Nerv Syst. 2024;40(6):1707-1719. doi: 10.1007/s00381-024-06306-x
16.Kopecky AS, Khan AJ, Pan W, Drachtman R, Parikh RR. Outcomes and patterns of care in a nationwide cohort of pediatric medulloblastoma: Factors affecting proton therapy utilization. Adv Radiat Oncol. 2017;2(4):588-596. doi: 10.1016/j.adro.2017.07.007
17.Rieken S, Gaiser T, Mohr A, Welzel T, Witt O, Kulozik AE, et al. Outcome and prognostic factors of desmoplastic medulloblastoma treated within a multidisciplinary treatment concept. BMC Cancer. 2010;10:450. doi: 10.1186/1471-2407-10-450
18.Pogorzala M, Styczynski J, Wysocki M. Survival and prognostic factors in children with brain tumors: long-term follow-up single center study in Poland. Anticancer Res. 2014 Jan;34(1):323-6. Available from: https://ar.iiarjournals.org/content/34/1/323.long
19.Igual Estellés L, Berlanga Charriel P, Cañete Nieto A. Meduloblastoma: mejoría de la supervivencia en las últimas décadas. Experiencia de un centro [Medulloblastoma: improved survival in recent decades. Unicentric experience]. An Pediatr (Barc). 2017;86(1):4-10. Spanish. doi: 10.1016/j.anpedi.2016.03.004
20.Walter AW, Mulhern RK, Gajjar A, Heideman RL, Reardon D, Sanford RA, et ak, Survival and neurodevelopmental outcome of young children with medulloblastoma at St Jude Children's Research Hospital. J Clin Oncol. 1999;17(12):3720-8. doi: 10.1200/JCO.1999.17.12.3720
21.Aarsen FK, van Veelen-Vincent MC, Partanen M, Catsman-Berrevoets CE. Perioperative risk factors for long-term intelligence in children with postoperative cerebellar mutism syndrome after medulloblastoma surgery. Pediatr Blood Cancer. 2022;69(3):e29536. doi: 10.1002/pbc.29536
22.Ai R, Liang Q, Deng G, Lai M, Hu Q, Li S, et al. Risk factors and risk prediction model for recurrence in medulloblastoma. Transl Pediatr. 2025;14(1):80-91. doi: 10.21037/tp-24-392
23.Kumar LP, Deepa SF, Moinca I, Suresh P, Naidu KV. Medulloblastoma: A common pediatric tumor: Prognostic factors and predictors of outcome. Asian J Neurosurg. 2015;10(1):50. doi: 10.4103/1793-5482.151516
24.Totapally BR, Shah AH, Niazi T. Epidemiology and short-term surgical outcomes of children presenting with cerebellar tumors. Clin Neurol Neurosurg. 2018;168:97-101. doi: 10.1016/j.clineuro.2018.02.038
25.Keeling C, Davies S, Goddard J, Ramaswamy V, Schwalbe EC, Bailey S, et al. The clinical significance of sub-total surgical resection in childhood medulloblastoma: a multi-cohort analysis of 1100 patients. EClinicalMedicine. 2024;69:102469. doi: 10.1016/j.eclinm.2024.102469
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