How To Increase Survival In 7 To 10% Of Patients With Average-Risk Medulloblastoma Without New Therapies: Early Prospective Neuroradiology Screening Experience From The Children'S Oncology Group

Abstract BACKGROUND Previous Children’s Oncology Group (COG) average-risk medulloblastoma studies retrospectively identified that 7 to 10% of patients were wrongly staged; either due to the presence of unequivocal residual disease greater than 1.5cm2 or metastatic disease. Notably, these patients had an inferior survival. The current COG front-line average-risk study for WNT-driven medulloblastoma patients, ACNS1422, is a reduced-intensity therapeutic protocol. Given the potentially devastating consequences of dose reduction in a wrongly staged patient, ACNS1422 is utilizing optimized MRI sequences, including thin slices with no gap and post contrast T2 FLAIR sequences, combined with a rapid central neuroradiology review. RESULTS The study opened on October 2 2017. As of 31 December 2019, a total of 34 patients have undergone central neuroradiology review. In 27/34 (79%) repeat scans were requested due to technically inadequate sequences (majority due to missing post contrast T2 FLAIR, slice thickness and gap issues). Of 19 repeat scans received, four patients (12%) were wrongly staged as average-risk; three patients were identified with residual disease >1.5cm2 (in 2 residual disease was confirmed at second resection) and one patient had widespread spinal metastases previously obscured by motion. In addition, metastatic disease was excluded in another patient, reported as having metastatic disease. CONCLUSION Our data is consistent with previous reports revealing that approximately 10% of patients are wrongly staged as average-risk. The early experience of ACNS1422 reveals that the optimized MRI sequences combined with a rapid central neuroradiology review are very valuable in a cooperative group setting to more accurately stage patients.