P10.11.b Spectrum of Medulloblastoma in Children: A Single Center Experience Over 15 Years

Abstract BACKGROUND To summarise our experience of spectrum of medulloblastoma in terms of incidence, clinical presentation, radiologic features, risk stratification, treatment strategies and outcome. MATERIAL AND METHODS This was a retrospective analysis of all newly diagnosed medulloblastoma patients registered in our department between January 1998 to March 2021. Demographic, disease, treatment details and follow-up status/outcome of these patients was abstracted from the e-medical records. All these patients underwent surgery followed by cranio-spinal radiation (CSRT) for children aged 3 years. This was followed by adjuvant chemotherapy as per POG 9031 protocol. RESULT A total of 138 children with brain tumors were registered and treated at our institute during the study period. Of these 49/138 (42.5%) were medulloblastoma. 40/49 (82%) were 3 years of age and 4/49(9%) were infants. Median age of presentation was 6 years (1 year - 25 year) with 70 % males. Majority of patients presented with vomiting 34% (17/49), focal neurological deficits -unsteady gait/diplopia/cranial nerve palsy 44%(21/49), headache 41%(20/49), others- irritability, feeding issues, loss of weight, fever 82%(40/49). Median duration of symptoms was 2 months (1 week- 1 year). Most patients (85%) revealed a midline tumour growing into the fourth ventricle on MRI. Leptomeningeal spread and spine seeding was reported in 20% and 19% patients respectively. Staging workup revealed 35 %(17/49) as metastatic, with 15% (7/94) being CSF positive. 45 %(22/49) were high risk as per modified chang’s staging. Surgery was performed for all patients and 88 %(43/49) underwent gross total or near total resection. 82 %(40/49) received CSRT, with median dose of 36gy and posterior fossa boost of 54gy. All patients received chemotherapy with tolerable toxicity. Over a median follow-up duration of 15 months (1-148months), 18 %(9/49) relapsed, 6 %(3/49) had progressive disease, 12 %(6/49) expired (3 relapse, 3 Progressive Disease). CONCLUSION In the present study, medulloblastoma were the commonest brain tumor, with vomiting and focal neurological signs as most reported symptoms. Treatment strategy included multimodal treatment with omission of CSRT in children 3 years. At follow-up 76% children were alive and disease free.