| Objective:To investigate the efficacy of comprehensive treatment of medulloblastoma(MB)in children and related factors affecting prognosis.Methods:Reviewing and analyzing 48 patients who underwent surgical resection of the medulloblastoma and received postoperative radiotherapy or/and chemotherapy in the Children’s Hospital of Chongqing Medical University from October 2008 to October 2018.The treatment was combined with surgery and adjuvant therapy.The adjuvant therapy was divided into chemotherapy group,radiotherapy+chemotherapy group and chemotherapy+radiotherapy+chemotherapy("sandwich chemotherapy")group.Tumor recurrence was used as the outcome index.Different treatment methods were compared to explore the advantages of adjuvant therapy.KaplanMeier method was used to evaluate factors affecting prognosis of MB based on age,pathological classification,risk grading,degree of tumor resection,tumor size,and chemotherapy start time.Univariate analysis and COX regression multivariate analysis were also used to analyze the factors that influence the prognosis of MB.Results:In this study,a total of 48 children with MB were enrolled in the study.36 patients with age over 3 had a 3-year overall survival(OS)rate of 90.6%,and children aged 3 years and younger had a 3-year OS rate of 75%.The 3-year event free survival(EFS)rate was 72.7%and 41.0%,respectively.For the 17 patients in the postoperative chemotherapy group,10 patients in the postoperative radiotherapy+chemotherapy group,and 21patients in the postoperative chemotherapy+radiotherapy+chemotherapy group,the 3-year OS were 82.3%,80.0%,and 95.2%,respectively;and3-year relapse-free survival(RFS)were 26.5%,66.7%,84.7%,respectively.The results of postoperative single factor analysis showed that:inter-variable,high-risk grading,age less than 3 years old,tumor metastasis at diagnosis(M2/M3)and postoperative tumor residual≥1.5cm~2 were risk factors for clinical prognosis of children with MB.Multivariate analysis showed that the residual tumors after tumor resection were≥1.5 cm~2,high-risk grading was an independent risk factor for clinical prognosis of MB in children..Conclusion:1.The treatment of MB in children is individualized with comprehensive treatment such as surgical resection,chemotherapy and radiotherapy.2.MB can be treated with"sandwich chemotherapy"combined with radiotherapy to improve RFS,but it also needs longer follow-up time.Radiotherapy is an indispensable adjuvant treatment for children with radiotherapy contraindications and radiotherapy.3.Data analysis showed that age,metamorphosis,and tumor metastasis were the poor prognostic risk factors.And residual tumor≥1.5 cm~2 after tumor resection and high-risk risk classification were independent risk factors for clinical poor prognosis of children with MB. |
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