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. 2020 Nov 26;22(11):1686-1695.
doi: 10.1093/neuonc/noaa083.

Role of neoadjuvant chemotherapy in metastatic medulloblastoma: a comparative study in 92 children

Léa Guerrini-Rousseau  1   2 , Rachid Abbas  3 , Sophie Huybrechts  4 , Virginie Kieffer-Renaux  1   5 , Stéphanie Puget  6 , Felipe Andreiuolo  7 , Kévin Beccaria  6 , Thomas Blauwblomme  6 , Stéphanie Bolle  8 , Frédéric Dhermain  8 , Audrey Longaud Valès  1 , Thomas Roujeau  9 , Christian Sainte-Rose  6 , Arnault Tauziede-Espariat  7 , Pascale Varlet  7 , Michel Zerah  6 , Dominique Valteau-Couanet  1 , Christelle Dufour  1   2 , Jacques Grill  1   2
Affiliations

Role of neoadjuvant chemotherapy in metastatic medulloblastoma: a comparative study in 92 children

Léa Guerrini-Rousseau et al. Neuro Oncol. .

Abstract

Background: Previous pilot studies have shown the feasibility of preoperative chemotherapy in patients with medulloblastoma, but benefits and risks compared with initial surgery have not been assessed.

Methods: Two therapeutic strategies were retrospectively compared in 92 patients with metastatic medulloblastoma treated at Gustave Roussy between 2002 and 2015: surgery at diagnosis (n = 54, group A) and surgery delayed after carboplatin and etoposide-based neoadjuvant therapy (n = 38, group B). Treatment strategies were similar in both groups.

Results: The rate of complete tumor excision was significantly higher in group B than in group A (93.3% vs 57.4%, P = 0.0013). Postoperative complications, chemotherapy-associated side effects, and local progressions were not increased in group B. Neoadjuvant chemotherapy led to a decrease in the primary tumor size in all patients; meanwhile 4/38 patients experienced a distant progression. The histological review of 19 matched tumor pairs (before and after chemotherapy) showed that proliferation was reduced and histological diagnosis feasible and accurate even after neoadjuvant chemotherapy. The 5-year progression-free and overall survival rates were comparable between groups. Comparison of the longitudinal neuropsychological data showed that intellectual outcome tended to be better in group B (the mean predicted intellectual quotient value was 6 points higher throughout the follow-up).

Conclusion: Preoperative chemotherapy is a safe and efficient strategy for metastatic medulloblastoma. It increases the rate of complete tumor excision and may improve the neuropsychological outcome without jeopardizing survival.

Key points: 1. Preoperative chemotherapy increases the rate of complete tumor removal.2. No additional risk (toxic or disease progression) is linked to the delayed surgery.3. Preoperative chemotherapy could have a positive impact on the neuropsychological outcome of patients.

Keywords: childhood brain tumor; medulloblastoma; neuropsychological outcome; preoperative chemotherapy; surgery.

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Figures

Fig. 1
Fig. 1
Response to neoadjuvant chemotherapy. (A) Radiological response to chemotherapy on brain MRI (sagittal sections T1 gadolinium) performed before and after neoadjuvant chemotherapy (scale bar 5 cm). Changes in the size of the primary tumor after neoadjuvant chemotherapy measured radiologically in 28 patients in group B with MRI at diagnosis and at the end of neoadjuvant chemotherapy available for comparison. Response was evaluated after 2 courses (23 patients), * 3 courses (3 patients), ** 4 courses (1 patient) or *** 8 courses (1 patient). (B) Medulloblastoma histopathological analysis before and after neoadjuvant chemotherapy. Sections showing: (B1 and B2) small blue round cell tumors consisting of densely packed undifferentiated embryonal cells (HPS), still existing after the adjuvant treatment (HPS) and (B3 and B4) significant decrease of the proliferation index (evaluated by MIB1 labeling index) between first surgery and the surgery after treatment (magnification 400x, scale bar 50µm). (C) Proliferation index changes after neoadjuvant chemotherapy in 17 patients from group B with available matched tumor pairs. (D) Progression-free survival in group A (surgery at diagnosis) and group B (surgery after neoadjuvant therapy) in function of time (years).
Fig. 2
Fig. 2
Changes of the predicted FSIQ in patients in function of the age class at diagnosis (≤5 and >5 y).
See this image and copyright information in PMC

Comment in

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