Retrospective Clinical Audit: The long-term sequelae of the combined treatment (surgery, radiotherapy and chemotherapy) for medulloblastoma in children and its profound effect on the quality of life in survivors.

 
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Hanin Tawfik*
University of Liverpool, UK*
Abstract
Background: Medulloblastoma, primitive neuroectodermal tumor (PNET), is the second most common brain tumour in childhood. Accounting for about 20% of central nervous system tumours and 40% of all posterior fossa tumours in children, between the ages of 1 and 9 (1, 2). The tumor is more common in males than females (3). Treatment consists of a combined approach that includes surgery, radiotherapy and chemotherapy (4).

Aims:To investigate the possible late-effects followingthe combined treatment for medulloblastoma in children. And to explore to what degree it can reduce the quality of life in the long-term survivors.

Methods: A review of the literature was undertaken on databases such as SCOPUS and PubMed. The retrospective audit consisted of collecting data from medical records of 22 histologically confirmed medulloblastoma from 1984 to 2010 with average age 9 years and 2 monthsat time of diagnosis at the Clatterbridge oncology centre.

Results:The children who received chemotherapy in addition to radiotherapy had lower scores on the quality of-life assessment than did those who received radiotherapy alone (5), and lower overall score on the Health Utility Index in a 7 year follow-up study (6).

The audit main findings were that all children who had undergone the combined treatment would experience acute and late effects. Overall, 22 cases out of which there were 15 boys and 7 girls, 59.1% experienced pituitary dysfunction (growth hormone deficiency) and 40.9% were diagnosed with second malignancies.

Conclusion: The aggressive treatment modalities leads to a greater survival but with this greater increase in survival comes the potential for a long-term unwanted effects such as physical and functional disabilities, or endocrine dysfunction (7).

New therapeutic agents are being tested for safety and efficacy. Yet, a great deal of work remains to be done to effect reliable therapies while reducing long-term sequelae (8).
References :
  1. Eric K. Hansen MRI. Handbook of evidence- based radiation oncology: Springer; 2007.
  2. Books B. evidence-based paediatric oncology: blackwell publishing; 2007.
  3. Singer M. The epidemiology of brain tumours in children. accessed 01/02/2012. Available from: http://www.childhoodbraintumor.org/THE%20EPIDEMIOLOGY%20OF%20BRAIN%20TUMORS_Part%201.pdf.
  4. Tidy DC. Brain Tumours in Children [accessed 01/02/2012]. Available from: http://www.patient.co.uk/doctor/Brain-Tumours-in-Children.htm.
  5. Roger J. Packer GV. Management and prognosis with medulloblastoma. Arch Neuroal. 2008; 65:1419-1124
  6. Packer RJ. Reduction of health status 7 years after addition of chemotherapy to cranio-spinal irradiation for medulloblastoma: a follow-up study on PNET-3 trial survivors. Curr Neurol Neurosci Rep. 2008;8:111-113.
  7. Silverman CL, Palkes H, Talent B, Kovnar E, Clouse JW, Thomas PR. Late effects of radiotherapy on patients with cerebellar medulloblastoma. Cancer. 1984;54:825-829
  8. Rood BR, Macdonald TJ, Packer RJ. Current treatment of medulloblastoma: recent advances and future challenges. Semin Oncol. 2004;31:666-675

DOI: 10.7199/ped.oncall.2014.
 
How to Cite URL :
Tawfik H.. Available From : http://www.pediatriconcall.com/conference/abstract/33/view/824
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