A Systematic Review For The Treatment Of Childhood Medulloblastoma Pre-radiation Chemotherapy Versus Radiotherapy Alone

Objective:1 To determine the outcome of pre-radiation chemotherapy versus radiotherapy for childhood medulloblastoma.2 To assess what are the prognostic factors for childhood medullublastoma.Methods:We searched MEDLINE(1966-2006.3), EMBASE(1974- 2006.3),The Cochrane Library and CBMdisc(1977-2006.3),and looked up the relevant Chinese and English neurosurgical journals.Randomized controlled trials and clinical controlled trials of pre-radiation chemotherapy versus radiotherapy alone for childhood medulloblastoma were included.The quality of trials were critically assessed.RevMan 4.2.8 software was used for analysis.Results:Four RCTs of pre-radiation chemotherapy versus radiotherapy for childhood medulloblastoma were included.The results of meta-analysis showed that pre-radiation chemotherapy for childhood medullublastoma increased the event-free survival[RR=1.21,95%CI(1.06, 1.38)P=0.004].More advantage of event-free survival achieved for children with advanced stages disease treated in radiotherapy plus chemotherapy group.The difference of overall survival failed to show statistically significant between two protocols. [RR=1.08,95%CI(0.95,1.23)P=0.24].Prognostic factors:The event-free survival rates between patients,who had gross complete removal of tumor versus less complete ones were significant deference.[OR=0.66,95%CI(0.47,0.93)P=0.02].The T-stage of tumor T1-2 Vs T3-4 and younger age Vs older age were significant deference achieved [OR=2.08,95%CI(1.47,2.94)P=0.0001]And[RR=0.67 95%CI(0.49 0.90)P=0.009]. Conclusions:Compared with radiotherapy alone the pre-radiation chemotherapy increased event-free survival rates for childhood medulloblastoma especially for children with advanced stages disease.The prognostic factors may be extent of surgical resection, patient's age and the T-stage of tumor.