Outcomes of pediatric medulloblastoma in low- and middle-income countries: A retrospective analysis of 335 cases from 8 countries

Abstract

Background: Reports from low- and middle-income countries (LMICs) indicate lower survival for children with medulloblastoma (MB), though these studies are mainly from single institutions or countries. This retrospective study aimed to analyze the outcomes for MB in 9 centers in 8 countries.

Methods: Patients <18 years with newly diagnosed MB, diagnosed between 2014 and 2018, were included. Clinical and biological characteristics were collected, and patient outcomes were analyzed.

Results: A total of 335 patients were included. The median age was 7.7 years, and 51 patients (15%) were <3 years old. Eighty-seven patients (26.0%) had experienced symptoms for more than 3 months before diagnosis. Of 326 (97.3%) patients who underwent resection, 153 (47%) had a gross total resection. Metastatic disease at diagnosis was identified in 82 patients (24.5%). Radiotherapy was administered to 213 patients (63.8%). A total of 117 deaths occurred, including 90 (76.9%) from tumor progression and 25 (21.4%) from surgical complications or infection. Sixty-three (18.9%) patients abandoned treatment. The 5-year event-free survival and overall survival (OS) were 43.8% ± 3.5% and 58.4% ± 3.7%, respectively. Younger age, presence of metastatic disease, and starting radiotherapy >42 days after diagnosis were not prognostic, while the degree of resection, presence of a severe infection, and a longer diagnostic interval were associated with worse outcomes.

Conclusions: This multinational cohort describes poor outcomes due to delays in care, high abandonment of treatment, surgical complications, and a low fraction of patients receiving radiotherapy. Interventions to build care capacity for children with MB in LMICs can be prioritized based on these data.

Keywords: global neuro-oncology; low- and middle-income countries; medulloblastoma; pediatric neuro-oncology.

Figure 1.

Cohort outcomes. (A) EFS and OS of the full cohort. (B) Abandonment-sensitive EFS and OS. (C) EFS is based on the patient’s age at diagnosis. (D) EFS is based on the presence of metastatic disease. (E) EFS is based on the degree of surgical resection. (F) EFS is based on the days between diagnosis and the start of radiotherapy. (G) EFS is based on the time between the first physician visit and diagnosis. (H) EFS is based on the presence of severe infection.