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Effects of the grow...
Effects of the growth pattern of medulloblastoma on short-term neurological impairments after surgery: results from the prospective multicenter HIT-SIOP PNET 4 study
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- Schepke, Elizabeth (author)
- Gothenburg University,Göteborgs universitet,Sahlgrenska Cancer Center
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- Tisell, Magnus, 1964 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience
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Kennedy, C. (author)
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Puget, S. (author)
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Ferroli, P. (author)
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Chevignard, M. (author)
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Doz, F. (author)
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Pizer, B. (author)
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Rutkowski, S. (author)
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Massimino, M. (author)
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Navajas, A. (author)
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Schwalbe, E. (author)
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Hicks, D. (author)
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Clifford, S. C. (author)
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Pietsch, T. (author)
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- Lannering, Birgitta, 1948 (author)
- Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics
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(creator_code:org_t)
- 2020
- 2020
- English.
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In: Journal of Neurosurgery-Pediatrics. - 1933-0707. ; 25:4, s. 425-433
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Abstract
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- OBJECTIVE Extensive resection of a tumor in the posterior fossa in children is associated with the risk of neurological deficits. The objective of this study was to prospectively evaluate the short-term neurological morbidity in children after medulloblastoma surgery and relate this to the tumor's growth pattern and to the extent of resection. METHODS In 160 patients taking part in the HIT-STOP PNET 4 (Hyperfractionated Versus Conventionally Fractionated Radiotherapy in Standard Risk Medulloblastoma) trial, neurosurgeons prospectively responded to questions concerning the growth pattern of the tumor they had resected. The extent of resection (gross, near, or subtotal) was evaluated using MRI. The patients' neurological status before resection and around 30 days after resection was recorded. RESULTS Invasive tumor growth, defined as local invasion in the brain or meninges, cranial nerve, or major vessel, was reported in 58% of the patients. After surgery almost 70% of all patients were affected by one or several neurological impairments (e.g., impaired vision, impaired extraocular movements, and ataxia). However, this figure was very similar to the preoperative findings. Invasive tumor growth implied a significantly higher number of impairments after surgery (p = 0.03) and greater deterioration regarding extraocular movements (p = 0.012), facial weakness (p = 0.048), and ataxia in the arms (p = 0.014) and trunk (p = 0.025) compared with noninvasive tumor growth. This deterioration was not dependent on the extent of resection performed. Progression-free survival (PFS) at 5 years was 80% +/- 4% and 76% +/- 5% for patients with invasive and noninvasive tumor growth, respectively, with no difference in the 5-year PFS for extent of resection. CONCLUSIONS Preoperative neurological impairments and invasive tumor growth were strong predictors of deterioration in short-term neurological outcome after medulloblastoma neurosurgery, whereas the extent of resection was not . Neither tumor invasiveness nor extent of resection influenced PFS. These findings support the continuation of maximal safe resection in medulloblastoma surgery where functional risks are not taken in areas with tumor invasion.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine (hsv//eng)
Keyword
- neurological sequelae
- resection
- growth pattern
- medulloblastoma
- pediatric neurosurgery
- cerebellar mutism syndrome
- CMS
- oncology
- posterior-fossa tumors
- standard-risk medulloblastoma
- cerebellar mutism
- syndrome
- central-nervous-system
- brain-tumors
- molecular subgroups
- outcome prediction
- prognostic-factors
- radiation-therapy
- controlled-trial
- Neurosciences & Neurology
- Pediatrics
- Surgery
Publication and Content Type
- ref (subject category)
- art (subject category)
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- By the author/editor
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Schepke, Elizabe ...
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Tisell, Magnus, ...
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Kennedy, C.
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Puget, S.
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Ferroli, P.
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Chevignard, M.
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show more...
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Doz, F.
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Pizer, B.
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Rutkowski, S.
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Massimino, M.
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Navajas, A.
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Schwalbe, E.
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Hicks, D.
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Clifford, S. C.
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Pietsch, T.
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Lannering, Birgi ...
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show less...
- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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Journal of Neuro ...
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University of Gothenburg