Abstract
We studied the impact of gross total resection on progression-free survival (PFS) and postoperative morbidity in 40 children with locally advanced meduUoblastoma characterized by tumor invading the brain stem. These patients represented 40% of children treated for newly diagnosed meduUoblastoma at a pediatric oncology center over a 10-year period. All patients underwent aggressive initial surgical resection. Review of surgical and neuro-imaging findings documented gross total resection in 13 cases, near-total resection (< 1.5 cm2 residual tumor on imaging) in 14 cases, and subtotal resection (> 50% resection with > 1.5 cm2 residual) in 13 cases. Overall, 85% of patients had a >90% resection. Subsequent therapy comprised craniospinal irradiation in all cases and chemotherapy on institutional or cooperative group protocols in 35 cases. At a median follow-up of 4 years, postirradiation PFS is 61% (SE = 10%). There was no difference in PFS for patients who underwent gross total resection compared to those with any detectable residual tumor (p > 0.70). The posterior fossa syndrome occurred in 25% of cases, and had no apparent relationship to the extent of resection (p > 0.5, exact test). In this series, true gross total resection was not associated with a PFS advantage when compared to strictly defined near-total and subtotal resection. Although there was no operative mortality, the frequency of the posterior fossa syndrome is of concern and emphasizes the need for careful consideration of the risk/benefit ratio in the surgical approach to this subgroup of patients.
Original language | English (US) |
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Pages (from-to) | 182-187 |
Number of pages | 6 |
Journal | Pediatric Neurosurgery |
Volume | 25 |
Issue number | 4 |
DOIs | |
State | Published - Jan 1 1996 |
Keywords
- Brain stem invasion
- Extent of resection
- MeduUoblastoma
- Pediatric tumors
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Surgery
- Clinical Neurology