Factors influencing outcomes of older children with medulloblastoma over 15 years in Peru, a resource‐limited setting

Abstract

Background: Medulloblastoma is the most common malignant brain tumor in children. While survival has improved in high-income countries (HIC), the outcomes for patients in low-to-middle-income countries (LMIC) are unclear. Therefore, we sought to determine the survival of children with medulloblastoma at the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 1997 and 2013 in Peru. Methods: Between 1997 and 2013, data from 103 children older than 3 years with medulloblastoma were analyzed. Fourteen patients were excluded. The patients were split into two distinct cohorts, 1997-2008 and 2009-2013, corresponding with chemotherapy regimen changes. Event-free (EFS) and overall survival (OS) were calculated using the Kaplan-Meier method, whereas prognostic factors were determined by univariate analysis (log-rank test).Results: Eighty-nine patients were included; median age was 8.1 years (range: 3-13.9 years). The 5-year OS was 62% (95% CI: 53%-74%), while EFS was 57% (95% CI: 48%-69%). The variables adversely affecting survival were anaplastic histology

Prognostic factors of pediatric ependymomas at a National Cancer Reference Center in Peru

“…A study conducted in Peru that included patients of ages 3 to 15 years with the diagnosis of medulloblastoma identified that a delay greater than 30 days in the initiation of radiotherapy after surgery was associated with a poor prognosis ( 43 ). In our cohort, only 1 patient commenced radiotherapy in the first 30 days after surgery, which may have limited the statistical significance of this factor.…”

Efficacy of intrathecal methotrexate in children with high-risk medulloblastoma over three years: a retrospective study from a single center

“…It has been established that 80% of children with cancer worldwide live in low-to-middle income countries and have inferior outcomes than children living in high income countries [ 25 , 26 ]. It is widely thought that delays in diagnosis and treatment compromise survival [ 27 ].…”

Pediatric neuro-oncology in Latin America and the Caribbean: a gap to be filled

“…Prompt diagnosis, referral, multidisciplinary approach, and local capacity are important tasks where interventions can improve the outcomes. An example of success due to the effort of well-structured services was the protocol for the treatment of intracranial germinoma, a recently published Brazilian consortium that demonstrated with a median follow-up of 44.5 months, overall and event-free survivals of 100% ( 29 , 30 ).…”

“…Another process to be filled in the task of diagnosis and treatment of pediatric brain tumors is to organize the referral pathways and the length during treatment. Diaz-Coronado et al, described that a child with medulloblastoma starting radiotherapy more than 30 days after surgery showed a negative impact on their survival ( 29 ).…”