MBCL-02. ROLE OF PREOPERATIVE CHEMOTHERAPY IN METASTATIC MEDULLOBLASTOMA: A COMPARATIVE STUDY IN 92 CHILDREN

• Published in: Neuro-oncology (Charlottesville, Va.) Va.), 2020-12, Vol.22 (Supplement_3), p.iii387-iii387
• Main Authors: Guerrini-Rousseau, Léa, Abbas, Rachid, Huybrechts, Sophie, Kieffer-Renaux, Virginie, Puget, Stéphanie, Andreiuolo, Felipe, Beccaria, Kevin, Blauwblomme, Thomas, Bolle, Stéphanie, Dhermain, Frédéric, Longaud, Audrey, Roujeau, Thomas, Rose, Christian Sainte, Tauziede-Esperiat, Arnaud, Varlet, Pascale, Zerah, Michel, Valteau-Couanet, Dominique, Dufour, Christelle, Jacques, Grill
• Format: Article
• Language: English
• Subjects: Medulloblastoma (Clinical)
• ISSN: 1522-8517; 1523-5866
• DOI: 10.1093/neuonc/noaa222.478

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, France, between 2002 and 2015: surgery at diagnosis (n=54; group A) and surgery delayed after carboplatin and etoposide-based preoperative 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% versus 57.4%, p=0.0013). Post-operative complications, chemotherapy-associated side effects and local progressions were not increased in group B. Preoperative chemotherapy led to a decrease in the primary tumor size in all patients, 4/38 patients experiencing meanwhile 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 preoperative 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.