Despite the use of adjuvant chemotherapy, deferral of postoperative radiotherapy is associated with worse survival in pediatric patients with medulloblastoma, a study published in JAMA Oncology has shown.1
Adjuvant radiotherapy delivered to the craniospinal axis is standard of care for children with medulloblastoma; however, it is associated with long-term morbidity, particularly in young children. In the modern era of adjuvant chemotherapy, postoperative radiotherapy is typically deferred in children younger than 3 years, but its use remains controversial in older children.
Therefore, researchers sought to analyze recent data from patients age 3 to 8 years with histologically confirmed medulloblastoma who were included in the National Cancer Database. Patients were only included if they did not have distant metastases, and underwent surgery and adjuvant chemotherapy with or without postoperative radiotherapy.
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Results showed that among the 816 patients included, 15.1% had radiotherapy deferred, defined as not having received radiotherapy within 90 days of surgery.
Researchers found that 36.8% of 3-year-old patients and 41.8% of 8-year-old patients had postoperative radiotherapy deferred (P <.001).
After adjusting for confounding variables, the study demonstrated that age and year of diagnosis were associated with postoperative radiotherapy deferral.
In addition, survival analyses revealed that postoperative radiotherapy deferral, stage M1-3 disease, and low facility volume were associated with poorer survival.
“The practice of postoperative radiotherapy deferral in young children with medulloblastoma seems to be increasing nationally despite postoperative radiotherapy’s association with improved overall survival,” the authors conclude.
Reference
1. Kann BH, Park HS, Lester-Coll NH, et al. Postoperative radiotherapy patterns of care and survival implications for medulloblastoma in young children. JAMA Oncol. 2016 Aug 4. doi: 10.1001/jamaoncol.2016.2547. [Epub ahead of print]
