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  • Schepke, ElizabethGothenburg University,Göteborgs universitet,Sahlgrenska Cancer Center (author)

Effects of the growth pattern of medulloblastoma on short-term neurological impairments after surgery: results from the prospective multicenter HIT-SIOP PNET 4 study

  • Article/chapterEnglish2020

Publisher, publication year, extent ...

  • 2020

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  • LIBRIS-ID:oai:gup.ub.gu.se/295837
  • https://gup.ub.gu.se/publication/295837URI
  • https://doi.org/10.3171/2019.11.Peds19349DOI

Supplementary language notes

  • Language:English

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • 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 and genre

  • MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin hsv//swe
  • MEDICAL AND HEALTH SCIENCES Clinical Medicine hsv//eng
  • 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

Added entries (persons, corporate bodies, meetings, titles ...)

  • Tisell, Magnus,1964Gothenburg University,Göteborgs universitet,Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap,Institute of Neuroscience and Physiology, Department of Clinical Neuroscience(Swepub:gu)xtisma (author)
  • Kennedy, C. (author)
  • Puget, S. (author)
  • Ferroli, P. (author)
  • Chevignard, M. (author)
  • Doz, F. (author)
  • Pizer, B. (author)
  • Rutkowski, S. (author)
  • Massimino, M. (author)
  • Navajas, A. (author)
  • Schwalbe, E. (author)
  • Hicks, D. (author)
  • Clifford, S. C. (author)
  • Pietsch, T. (author)
  • Lannering, Birgitta,1948Gothenburg University,Göteborgs universitet,Institutionen för kliniska vetenskaper, Avdelningen för pediatrik,Institute of Clinical Sciences, Department of Pediatrics(Swepub:gu)xlabir (author)
  • Göteborgs universitetSahlgrenska Cancer Center (creator_code:org_t)

Related titles

  • In:Journal of Neurosurgery-Pediatrics25:4, s. 425-4331933-0707

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