Clinical outcome of pediatric medulloblastoma patients with Li-Fraumeni syndrome

Anna S. Kolodziejczak, Lea Guerrini-Rousseau, Julien Masliah Planchon, Jonas Ecker, Florian Selt, Martin Mynarek, Denise Obrecht, Martin Sill, Robert J. Autry, Eric Stutheit-Zhao, Steffen Hirsch, Elsa Amouyal, Christelle Dufour, Olivier Ayrault, Jacob Torrejon, Sebastian M. Waszak, Vijay Ramaswamy, Virve Pentikainen, Haci Ahmet Demir, Steven C. CliffordEd C. Schwalbe, Luca Massimi, Matija Snuderl, Kristyn Galbraith, Matthias A. Karajannis, Katherine Hill, Bryan K. Li, Mike Walsh, Christine L. White, Shelagh Redmond, Loizou Loizos, Marcus Jakob, Uwe R. Kordes, Irene Schmid, Julia Hauer, Claudia Blattmann, Maria Filippidou, Gianluca Piccolo, Wolfram Scheurlen, Ahmed Farrag, Kerstin Grund, Christian Sutter, Torsten Pietsch, Stephan Frank, Denis M. Schewe, David Malkin, Myriam Ben-Arush, Astrid Sehested, Tai-Tong Wong, Kuo-Sheng Wu, Yen-Lin Liu, Fernando Carceller, Sabine Mueller, Schuyler Stoller, Michael D. Taylor, Uri Tabori, Eric Bouffet, Marcel Kool, Felix Sahm, Andreas von Deimling, Andrey Korshunov, Katja Von Hoff, Christian P. Kratz, Dominik Sturm, David T.W. Jones, Stefan Rutkowski, Cornelis M. van Tilburg, Olaf Witt, Gaëlle Bougeard, Kristian W. Pajtler, Stefan M. Pfister, Franck Bourdeaut, Till Milde*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Abstract

Background
The prognosis for Li-Fraumeni syndrome (LFS) patients with medulloblastoma (MB) is poor. Comprehensive clinical data for this patient group is lacking, challenging the development of novel therapeutic strategies. Here, we present clinical and molecular data on a retrospective cohort of pediatric LFS MB patients.

Methods
In this multinational, multicenter retrospective cohort study, LFS patients under 21 years with MB and class 5 or class 4 constitutional TP53 variants were included. TP53 mutation status, methylation subgroup, treatment, progression free- (PFS) and overall survival (OS), recurrence patterns, and incidence of subsequent neoplasms were evaluated.

Results
The study evaluated 47 LFS individuals diagnosed with MB, mainly classified as DNA methylation subgroup “SHH_3” (86%). The majority (74%) of constitutional TP53 variants represented missense variants. The 2- and 5-year (y-) PFS were 36% and 20%, and 2- and 5y-OS were 53% and 23%, respectively. Patients who received post-operative radiotherapy (RT) (2y-PFS: 44%, 2y-OS: 60%) or chemotherapy before RT (2y-PFS: 32%, 2y-OS: 48%) had significantly better clinical outcome then patients who were not treated with RT (2y-PFS: 0%, 2y-OS: 25%). Patients treated according to protocols including high-intensity chemotherapy and patients who received only maintenance-type chemotherapy showed similar outcomes (2y-PFS: 42% and 35%, 2y-OS: 68% and 53%, respectively).

Conclusions
LFS MB patients have a dismal prognosis. In the presented cohort use of RT significantly increased survival rates, whereas chemotherapy intensity did not influence their clinical outcome. Prospective collection of clinical data and development of novel treatments are required to improve the outcome of LFS MB patients.
Original languageEnglish
Article numbernoad114
Pages (from-to)2273-2286
Number of pages14
JournalNeuro-Oncology
Volume25
Issue number12
Early online date28 Jun 2023
DOIs
Publication statusPublished - 1 Dec 2023

Keywords

  • Li–Fraumeni syndrome
  • TP53
  • medulloblastoma
  • survival

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