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. 2017 Jul 19;2(4):588-596.
doi: 10.1016/j.adro.2017.07.007. eCollection 2017 Oct-Dec.

Outcomes and patterns of care in a nationwide cohort of pediatric medulloblastoma: Factors affecting proton therapy utilization

Andrew S Kopecky  1 , Atif J Khan  2 , Wilbur Pan  3 , Richard Drachtman  3 , Rahul R Parikh  2
Affiliations

Outcomes and patterns of care in a nationwide cohort of pediatric medulloblastoma: Factors affecting proton therapy utilization

Andrew S Kopecky et al. Adv Radiat Oncol. .

Abstract

Purpose: We examined national outcomes and patterns of care for pediatric patients with medulloblastoma (MB) in a large observational cohort.

Methods and materials: Using the National Cancer Database, we evaluated the clinical features and survival outcomes of patients diagnosed with MB. The association between intervention, covariables, and outcome was assessed in a multivariable Cox analysis and through logistic regression analysis. Survival was estimated using the Kaplan-Meier method.

Results: Among the 4032 patients in the National Cancer Database with pediatric brain tumors, 1300 patients met the inclusion criteria of histologic diagnosis, receipt of chemotherapy and radiation, and age ≤18 years. The median age and follow-up were 8.4 years and 4.5 years, respectively. Five-year survival was 79.0%. In the univariate analysis, inferior outcome (overall survival) was associated with rural residence (hazard ratio [HR], 2.78; 95% confidence interval [CI],1.47-5.29; P < .01) and histology (large cell; HR, 1.78; 95% CI,1.08-2.94; P < .05). In multivariable analysis, both remained significant predictors of survival (large cell: HR, 1.68; P < .05; rural residence: HR, 2.74; P < .01). In 2013, the utilization rate of proton therapy (23% of patients) in the United States surpassed intensity modulate radiation therapy (16%), more frequently for patients with higher income (P < .05) or more favorable insurance status (P < .05).

Conclusions: As one of the largest data sets on pediatric MB, the observed variations in treatment intervention and survival outcomes may represent a target for further research.

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Figures

Figure 1
Figure 1
CONSORT diagram.
Figure 2
Figure 2
Overall survival for the entire cohort. The 5-year overall survival was 79.0% for all pediatric patients with medulloblastoma.
Figure 3
Figure 3
Overall survival by tumor histology. The 5-year overall survival of patients with classic/not otherwise specified histology was 79.0% versus 87.4% for patients with desmoplastic histology versus 67.8% for patients with large cell histology. (P < .01, Wilcoxon test).
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References

    1. Louis D.N., Ohgaki H., Wiestler O.D., Cavenee W.K., editors. WHO Classification of Tumours of the Central Nervous System. IARC Press; Lyon, France: 2007. - PMC - PubMed
    1. Louis D.N., Perry A., Reifenberger G. The 2016 World Health Organization classification of tumors of the central nervous system: A summary. Acta Neuropathol. 2016;131:803–820. - PubMed
    1. Gessi M., Pietsch T. Deciphering the real incidence of medulloblastoma with extensive nodularity in adult patients. J Neurooncol. 2016;130:237–238. - PubMed
    1. Ostrom Q.T., Gittleman H., Fulop J. CBTRUS Statistical Report: Primary brain and central nervous system tumors diagnosed in the United States in 2008-2012. Neuro Oncol. 2015;17:iv1–iv62. - PMC - PubMed
    1. McNeil D.E., Coté T.R., Clegg L., Rorke L.B. Incidence and trends in pediatric malignancies medulloblastoma/primitive neuroectodermal tumor: A SEER update. Med Pediatr Oncol. 2002;39:190–194. - PubMed