Long-term outcome of the Milano-HART strategy for high-risk medulloblastoma, including the impact of molecular subtype.

IF 16.4 1区 医学 Q1 CLINICAL NEUROLOGY Neuro-oncology Pub Date : 2024-09-27 DOI:10.1093/neuonc/noae189
Maura Massimino, Francesco Barretta, Chiara Dossena, Simone Minasi, Francesca Romana Buttarelli, Veronica Biassoni, Matilde Oriani, Elisabetta Schiavello, Marica Ficorilli, Olga Nigro, Bianca Pollo, Manila Antonelli, Vittoria Donofrio, Marco Maggioni, Marcel Kool, Emilia Pecori, Sabina Vennarini, Felice Giangaspero, Francesca Gianno, Alessandra Erbetta, Luisa Chiapparini, Roberto Luksch, Elena Barzanò, Cristina Meazza, Marta Podda, Filippo Spreafico, Monica Terenziani, Luca Bergamaschi, Andrea Ferrari, Michela Casanova, Stefano Chiaravalli, Giovanna Gattuso, Piergiorgio Modena, Simon Bailey, Loris De Cecco
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引用次数: 0

Abstract

Background: We applied the strategy for M+ medulloblastoma across all high-risk subgroups, including LC/A histology, TP53 mutations, MYC/MYCN amplification.

Methods: Patients over 3-years-old received,after surgery,staging and histo-biological analysis,sequential high-dose-methotrexate(HD-MTX),high-dose-etoposide(HD-VP16),high-dose-cyclophosphamide(HD-Cyclo),high-dose-carboplatin(HD-Carbo).Hyperfractionated-accelerated-radiotherapy-craniospinal(HART-CSI),administered in twice daily 1.3 Gy-fractions reached a total dose tailored to the patients' age and pre-radiation response to chemotherapy(CT): 31.2 Gy if under 10-years-old and complete response(CR) or partial response(PR) obtained or absence of metastatic disease,39 Gy in other/older patients.Boosts to posterior fossa/residual metastatic(M+) deposits were given up to a total dose of 60 Gy/9 Gy,respectively,but avoided if metastatic nodules were very big or patients very young.Two courses of high-dose-thiotepa were delivered in case of not CR/PR after pre-radiotherapy(RT) phase and in all M0 patients either - pre/post HART.Subgrouping was performed where tissue was available.

Results: Eighy-nine patients were enrolled,median age 8.8 years,median follow up 136 months.Overall-survival(OS) and event-free-survival(EFS) at 5/15 years were 75.9/66.5% and 68.2/65.3%, respectively;5/28 fatal events were not related to relapse(three developed secondary malignancies).Sex,age less than 10 years,histological subtype,presence of MYC/MYCN amplification,reduction in CSI dose,omission of RT-boosts,implementation of myeloablative therapy,presence/absence of metastases did not impact prognosis.Patients progressing after pre-HART CT(14/89) and stable-disease(SD)+PD after HART(10/89) negatively affected outcome(P<0.001).Subgrouping in 66/89 patients' samples demonstrated a significantly worse EFS for patients with Sonic Hedgehog(SHH)-tumors(#15, 2 with constitutional TP53-mutations) vs. group 3 and 4(15 and 29 patients, respectively, group3/4 in 7).Patients younger than 10 received lower CSI doses if stratified according to CT response.

Conclusions: This strategy, partly adopted in the ongoing SIOPE protocol,confirmed improved EFS and OS over previously reported outcomes in all high-risk categories;SHH tumors appeared the most aggressive.

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针对高风险髓母细胞瘤的米兰-HART策略的长期疗效,包括分子亚型的影响。
背景:我们将M+髓母细胞瘤的治疗策略应用于所有高风险亚组,包括LC/A组织学、TP53突变、MYC/MYCN扩增:3岁以上患者在接受手术、分期和组织生物学分析后,依次接受大剂量甲氨蝶呤(HD-MTX)、大剂量依托泊苷(HD-VP16)、大剂量环磷酰胺(HD-Cyclo)和大剂量卡铂(HD-Carbo)治疗。根据患者的年龄和放疗前的化疗反应(CT),以每天两次、每次 1.3 Gy 的分次剂量进行超分次加速放疗-颅骨脊髓放疗(HART-CSI),使总剂量达到:31.对后窝/残余转移(M+)病灶分别给予最高达 60 Gy/9 Gy 的总剂量,但如果转移结节非常大或患者非常年轻,则避免使用。在放疗前(RT)阶段未达到CR/PR的患者和所有M0患者在HART前/后接受两个疗程的大剂量噻替派治疗:5/15年的总生存率(OS)和无事件生存率(EFS)分别为75.9%/66.5%和68.2%/65.3%;5/28例死亡事件与复发无关(3例发展为继发性恶性肿瘤)。性别、年龄小于10岁、组织学亚型、MYC/MYCN扩增、CSI剂量减少、不使用RT-boosts、实施髓内消融治疗、有无转移灶等因素均不影响预后:正在进行的SIOPE方案部分采用了这一策略,证实与之前报道的结果相比,该策略改善了所有高危类别患者的EFS和OS;SHH肿瘤似乎最具侵袭性。
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来源期刊
Neuro-oncology
Neuro-oncology 医学-临床神经学
CiteScore
27.20
自引率
6.30%
发文量
1434
审稿时长
3-8 weeks
期刊介绍: Neuro-Oncology, the official journal of the Society for Neuro-Oncology, has been published monthly since January 2010. Affiliated with the Japan Society for Neuro-Oncology and the European Association of Neuro-Oncology, it is a global leader in the field. The journal is committed to swiftly disseminating high-quality information across all areas of neuro-oncology. It features peer-reviewed articles, reviews, symposia on various topics, abstracts from annual meetings, and updates from neuro-oncology societies worldwide.
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