Baqai Muhammad Waqas Saeed, Tariq Rabeet, Shah Zara, Bajwa Mohammad Hamza, Shamim Muhammad Shahzad
Department of Neurosurgery, Southmead Hospital, North Bristol, Southmead Rd, Bristol, BS10 5NB, England.
Department of Neurosurgery, Liaquat National Hospital and Medical College, Karachi, Pakistan.
Childs Nerv Syst. 2023 May;39(5):1159-1171. doi: 10.1007/s00381-023-05886-4. Epub 2023 Feb 24.
Medulloblastoma (MB) is the most common malignant pediatric brain tumor. The mainstay of treatment is maximum surgical resection and craniospinal radiation, which may be followed by chemotherapy. The debilitating effect of the tumor and the intensive treatment approaches in MB lead to long-term neuropsychological, physical, and chronic medical problems. We conducted a systematic review to assess the quality of life (QoL) in the long-term survivors of MB and the factors leading to compromised QoL.
We utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for our review. A comprehensive literature search was performed using PubMed, Cochrane Library, Digital Commons Network, and Wiley Online Library databases to search for articles having quality of life, medulloblastoma, and pediatric survivors in title or abstract. We removed duplicates and screened through titles, and full texts. Twelve articles were included in our study. Articles using and reporting all domains of PaedsQL were included in the meta-analysis. The PaedsQL scores of survivors and their caregivers were compared. Subgroup analysis was conducted for craniospinal and proton radiotherapy groups.
As compared to other posterior fossa tumors, MB survivors have the lowest QoL scores. There is a difference in the perception of QoL of survivors between caregivers and survivors themselves with survivors rating themselves higher in several domains. The overall PaedsQL scores were significantly different for both groups (p < 0.001). Subgroup analysis showed that the difference between those who were treated with craniospinal or proton radiation was not significant (p = 0.76). For the subscales, physical (p = 0.005), psychosocial (p = 0.0003), and school (p = 0.03) perceptions were significantly different for the survivors and their caregivers; however, psychosocial (p = 0.80) and emotional (p = 0.93) scales were not different for the survivors or caregivers. Patient characteristics related to a worse QoL included disease severity, metastatic disease, lesser family income, smaller current ventricle size, need for permanent hydrocephalus treatment, and lesser age at diagnosis.
An analysis of various studies, using different measures of QoL, concludes that QoL is compromised in all pediatric survivors of MB; however, the perception of QoL of the survivors is better than objective or caretaker-rated QoL.
髓母细胞瘤（MB）是儿童最常见的恶性脑肿瘤。主要治疗方法是最大限度的手术切除和颅脊髓放疗，之后可能进行化疗。MB肿瘤的致残作用以及强化治疗方法会导致长期的神经心理、身体和慢性医疗问题。我们进行了一项系统评价，以评估MB长期幸存者的生活质量（QoL）以及导致QoL受损的因素。
我们在评价中采用了系统评价和Meta分析的首选报告项目（PRISMA）指南。使用PubMed、Cochrane图书馆、数字公共网络和Wiley在线图书馆数据库进行全面的文献检索，以查找标题或摘要中包含生活质量、髓母细胞瘤和儿科幸存者的文章。我们去除了重复项，并通过标题和全文进行筛选。12篇文章纳入我们的研究。使用并报告儿童生活质量量表（PaedsQL）所有领域的文章纳入Meta分析。比较了幸存者及其照顾者的PaedsQL评分。对颅脊髓放疗组和质子放疗组进行亚组分析。
与其他后颅窝肿瘤相比，MB幸存者的QoL得分最低。照顾者和幸存者自身对幸存者QoL的认知存在差异，幸存者在几个领域给自己的评分更高。两组的总体PaedsQL得分有显著差异（p<0.001）。亚组分析表明，接受颅脊髓放疗或质子放疗的患者之间的差异不显著（p = 0.76）。对于各子量表，幸存者及其照顾者在身体（p = 0.005）、心理社会（p = 0.0003）和学校（p = 0.03）认知方面存在显著差异；然而，幸存者或照顾者在心理社会（p = 0.80）和情绪（p = 0.93）量表方面没有差异。与较差QoL相关的患者特征包括疾病严重程度、转移性疾病、家庭收入较低、当前脑室较小、需要永久性脑积水治疗以及诊断时年龄较小。
对使用不同QoL测量方法的各种研究进行分析得出结论，所有MB儿科幸存者的QoL均受损；然而，幸存者对QoL的认知优于客观或照顾者评定的QoL。
