Application of individualized therapy based on molecular classification in the treatment of medulloblastoma in children

Abstract

Objective To explore the clinical efficacy of individualized therapy based on molecular classification in the treatment of medulloblastoma in children. Methods The clinical data of 23 children with medulloblastoma confirmed by pathology after surgery from December 2017 to December 2019 were analyzed retrospectively. The 5 ⁃ year survival rate risk was stratified according to tumor molecular classification, and individualized chemoradiotherapy were given. Chemoradiotherapy response, postoperative complications and tumor recurrence were recorded. Results There were 23 cases of medulloblastoma. The tumor molecular genes were classified as WNT type 3 cases, SHH type 7 cases, Group3 type 5 cases and Group4 type 8 cases. The patients were divided into 4 groups according to the results of molecular classification as risk factors: low risk group (n = 5), standard risk group (n = 8), high risk group (n = 5) and very high risk group (n = 5). Total tumor resection was performed in 20 cases, subtotal resection in 3 cases. Three cases with hydrocephalus aggravated after surgery, 2 cases with cerebellar silence, 3 cases with cough paralysis and other neurological symptoms, which were relieved after symptomatic treatment. Individualized treatment (radiotherapy + chemotherapy) was carried out according to the risk stratification. The mean postoperative follow ⁃ up period was (15.15 ± 3.45) months. The tolerance of radiotherapy and chemotherapy in the low risk group and the standard risk group was strong, and no tumor recurrence was observed. After radiotherapy and chemotherapy, the high risk group and the very high risk group showed obvious bone marrow suppression and gastrointestinal symptoms, which were relieved after symptomatic treatment, and there were 2 cases in the high risk group and 3 cases in the very high risk group occuring tumor recurrence. Conclusions The risk stratification based on molecular classification is more accurate, and the individualized therapy could avoid excessive or insufficient clinical treatment, which is worthy of clinical promotion.DOI：10.3969/j.issn.1672⁃6731.2020.04.008