PTHP-22. Does the Extent of Resection matter In Medulloblastomas? In an era of Molecular Subgrouping: A single-center Indian study

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Abstract Molecular subgrouping (MS) has stratified outcomes in medulloblastoma, while the extent of resection (EOR) remains the standard of care. When gross total resection (GTR) is not possible due to the tumor’s invasive nature or risk of neurological deficits, MS can guide decisions on adjuvant therapy versus redo surgery. Although radiomics can suggest possible molecular subgroups, intraoperative pathological testing has not yet evolved to confirm subgroups for surgical decisions. We retrospectively analyzed single-center data on medulloblastomas with MS to assess the impact of EOR on overall survival (OS) and progression-free survival (PFS) across various subgroups. Out of 593 patients, 296 were included in the final analysis. When EOR was evaluated for the entire cohort, radical resection was associated with better OS, but a similar benefit was not observed with PFS. Kaplan-Meier curves showed better 5-year OS and PFS in the WNT subgroup compared to others. In subgroup analysis, EOR did not alter OS or PFS in WNT, SHH, and group 4. In group 3, OS was unaffected, but PFS was significantly better in the GTR+NTR group compared to STR (p=0.039). Multivariate analysis revealed that EOR did not influence OS or PFS in any subgroup. In group 3, EOR impacts OS and PFS, while factors like metastasis at presentation and incomplete adjuvant treatment also affect outcomes. Despite challenges in intraoperative MS analysis, maximal and safe surgical resection should be pursued, as chasing residual tumors does not alter outcomes in medulloblastomas except in group 3.

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