Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma

Abstract

<jats:sec> <jats:title>OBJECT</jats:title> <jats:p>The purpose of this study was to explore the clinical features and outcome of medulloblastoma in Chinese children. The authors analyze the reasons that treatment is abandoned and attempt to provide evidence-based recommendations for improving the prognosis of medulloblastoma in this population.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>A total of 67 pediatric cases of newly diagnosed medulloblastoma were included in this study. All of the children were treated at Xinhua Hospital between January 2007 and June 2013. The authors retrospectively analyzed the clinical data, treatment modalities, and outcome. The male-to-female ratio was 2:1, and the patients’ median age at diagnosis was 51.96 months (range 3.96–168.24 months). The median duration of follow-up was 32 months (range 3–70 months).</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>At the most recent follow-up date, 31 patients (46%) were alive, 30 (45%) had died, and 6 (9%) had been lost to follow-up. The estimated 3-year overall survival and progression-free survival, based on Kaplan-Meier analysis, were 55.1% ± 6.4% and 45.6% ± 6.7%, respectively. Univariate analysis showed that standard-risk group (p = 0.009), postoperative radiotherapy (RT) combined with chemotherapy (p &lt; 0.001), older age (≥ 3 years) at diagnosis (p = 0.010), gross-total resection (p = 0.012), annual family income higher than $3000 (p = 0.033), and living in urban areas (p = 0.008) were favorable prognostic factors. Multivariate analysis revealed that postoperative RT combined with chemotherapy was an independent prognostic factor (p &lt; 0.001). The treatment abandonment rate in this cohort was 31% (21 of 67 cases).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>There was a large gap between the outcome of medulloblastoma in Chinese children and the outcome in Western children. Based on our data, treatment abandonment was the major cause of therapeutic failure. Parents’ misunderstanding of medulloblastoma played a major role in abandonment, followed by financial and transportation difficulties. Establishment of multidisciplinary treatment teams could improve the prognosis of medulloblastoma in Chinese children.</jats:p></jats:sec>

The magnitude and predictors of therapy abandonment in pediatric central nervous system tumors in low‐ and middle‐income countries: Systematic review and meta‐analysis

“…In the study by Sun et al, the one patient who abandoned during chemotherapy while having progressive disease subsequently died of disease . In children with medulloblastoma, treatment abandonment was found to significantly decrease the three‐year OS (87.8% ± 5.7% for patients with complete treatment versus 25.2% ± 10.7% for those who abandoned treatment, P < 0.001) . In children with brainstem gliomas, all nine patients who refused treatment following diagnosis expired within eight months with a median time of 3.5 months .…”

“…The methodology in the remaining eight was not reported . Eight studies defined abandonment, ranging from missing two appointments to missing four weeks of therapy . Only 13 studies actively followed up cases of abandonment to minimize misclassification …”

“…However, authors of 12 studies reported possible causes of abandonment (Table ), based on their personal experience with patients, patient records, and knowledge of patients’ backgrounds . Only one (Chinese) study conducted a questionnaire with caregivers to identify reasons for abandonment . The top three reasons cited include severe side effects during postop therapy, belief that CNS tumor was incurable, and misconceptions about the treatment aims and prognosis of medulloblastoma.…”

“…In Jordan, a twinning program between King Hussein Cancer Center (Amman, Jordan) and Hospital for Sick Children (Toronto, Ontario, Canada) that utilized teleconferencing to enable real‐time sharing of expertise for individual patient management was found to reduce abandonment in medulloblastoma . In Shanghai, China, the introduction of a neurooncology multidisciplinary team in Xinhua hospital increased patient compliance with postoperative adjuvant therapy and reduced the ARs from 43% to 22% ( P = 0.069) . In Paraguay, the provision of socioeconomic support in the form of food, housing, transportation, and temporary employment for patients’ families contributed to a reduction in treatment abandonment …”

“…The reasons for the survival gap are a complex interplay of underdiagnosis, delayed presentation, and unavailability or inaccessibility of multidisciplinary neurooncology treatment facilities . In addition, a recent report stressed that abandonment of treatment, defined as the failure to start or complete potentially curative therapy, remains a key contributor to poor outcomes …”