Peer-reviewed article

MEDB-38. Significance of CSF cytology and neurologic deterioration in relapsed medulloblastomas in the German HIT-REZ-97/-2005 Studies and the HIT-REZ-Register

· 1 Jun 2022

Summary

Written by AI, not yet AICS's view · claude-haiku-4-5-20251001

This is a medical research study about medulloblastoma, a type of brain cancer in children. The study examines how certain clinical indicators at cancer relapse, specifically abnormal cerebrospinal fluid findings and worsening neurological symptoms, relate to survival outcomes. The research analysed 342 patients from German cancer treatment registries and found that children with these indicators had shorter survival times.

Key points

Patients with tumour cell-positive CSF cytology had median progression-free survival of 9.1 months versus 16.8 months for negative CSF
Patients with tumour cell-positive CSF had median overall survival of 14.4 months versus 41.8 months for negative CSF
New or worsened neurological impairment at relapse associated with median progression-free survival of 8.2 months versus 14.9 months
SHH-activated and group 3 medulloblastomas showed shortest survival times across all groups
Findings may inform patient counselling and treatment recommendations at cancer relapse

Limitations

This is a retrospective observational study analysing clinical registries rather than an experimental intervention evaluation. The study cannot establish causal relationships between the clinical indicators and outcomes, nor can it evaluate the effectiveness of any specific treatment approach.

Abstract

Abstract BACKGROUND: Follow-up examinations are an essential part of the aftercare of patients with brain tumours. We investigated survival in relation to neurological impairment and positive CSF findings at first relapse/progression of medulloblastomas. METHODS: We collected data from patients with relapsed medulloblastoma from the German HIT-REZ studies (HIT-REZ-1997, HIT-REZ-2005, HIT-REZ-Register, n=342). Survival differences dependent on tumour cell-positive and -negative CSF cytology as well as on new onset or worsening of neurological impairment (i.e. headache, nausea/vomiting, ataxia, seizures and others) were analysed. RESULTS: 247 patients with a recurrent medulloblastoma were evaluable for CSF cytology at first relapse/progression (positive n=97, negative n=150). Patients with tumour cell-positive CSF results showed a significantly shorter median PFS and OS time compared to patients with negative CSF cytology [PFS: 9.1 (CI: 5.3-12.9) vs. 16.8 (CI: 13.8-19.8) months, plog rank test=0.001; OS: 14.4 (CI: 12.3-16.4) vs. 41.8 (CI: 33.3–50.4) months, plog rank test<0.001]. The shortest PFS and OS were observed in SHH-activated (n=18) and group 3 medulloblastomas (n=23) independently of CSF cytology result [median PFSSHH: 4.3 (CI:1.1-12.2), OSSHH: 6.3 (CI:1.1-18.7); PFSgroup3: 4.2 (CI:2.3-13.1), OSgroup3: 13.2 (CI:7.1-18.5) months]. For analysis of the impact of neurological deterioration on survival at first relapse, 249 Patients were evaluable. 105 patients with new or severely worsened neurological impairment at first relapse/progression displayed a significantly poorer PFS and OS time in comparison to 144 patients with unchanged or improved neurological symptoms [PFS: 8.2 (CI: 6.0-10.3) vs. 14.9 (CI: 12.0-17.9) months, plog rank test=0.001; OS: 15.1 (CI: 9.5-20.6) vs. 32.6 (CI: 26.2-38.4) months, plog rank test<0.001]. CONCLUSIONS: Patients with relapsed medulloblastoma show significantly worse survival (PFS and OS) in presence of positive CSF cytology or neurologic deterioration at relapse. These findings could be relevant for patient/parents counselling and treatment recommendations at relapse. Funded by the German Children Cancer Foundation