Long Time to Diagnosis of Medulloblastoma in Children Is Not Associated with Decreased Survival or with Worse Neurological Outcome

Abstract

BackgroundThe long time to diagnosis of medulloblastoma, one of the most frequent brain tumors in children, is the source of painful remorse and sometimes lawsuits. We analyzed its consequences for tumor stage, survival, and sequelae.Patients and MethodsThis retrospective population-based cohort study included all cases of pediatric medulloblastoma from a region of France between 1990 and 2005. We collected the demographic, clinical, and tumor data and analyzed the relations between the interval from symptom onset until diagnosis, initial disease stage, survival, and neuropsychological and neurological outcome.ResultsThe median interval from symptom onset until diagnosis for the 166 cases was 65 days (interquartile range 31–121, range 3–457). A long interval (defined as longer than the median) was associated with a lower frequency of metastasis in the univariate and multivariate analyses and with a larger tumor volume, desmoplastic histology, and longer survival in the univariate analysis, but not after adjustment for confounding factors. The time to diagnosis was significantly associated with IQ score among survivors. No significant relation was found between the time to diagnosis and neurological disability. In the 62 patients with metastases, a long prediagnosis interval was associated with a higher T stage, infiltration of the fourth ventricle floor, and incomplete surgical resection; it nonetheless did not influence survival significantly in this subgroup.ConclusionsWe found complex and often inverse relations between time to diagnosis of medulloblastoma in children and initial severity factors, survival, and neuropsychological and neurological outcome. This interval appears due more to the nature of the tumor and its progression than to parental or medical factors. These conclusions should be taken into account in the information provided to parents and in expert assessments produced for malpractice claims.

Delays in Diagnosis of Childhood Cancer in Southeastern Turkey and the Associated Factors

“…It was not associated with an adverse outcome in medulloblastoma [20]. In leukemia patients, the delay did not have an impact on survival [21].…”

Prognostic and clinical implication of a disintegrin and metalloprotease 8 expression in pediatric medulloblastoma

“…As the most common malignant intracranial tumor in childhood, medulloblastoma represents a very heterogeneous group of biologically different tumor subsets arising from stem and/or progenitor cells of the cerebellum [1]. The clinical outcome for patients with medulloblastoma has been improved dramatically over the past decades.…”

Advanced‐stage cancer and time to diagnosis: An International Cancer Benchmarking Partnership (ICBP) cross‐sectional study

“…Instead of questioning their study design, many have ignored statistically significant reverse effects and claimed that the time duration of both diagnostic and treatment processes is too short to have any clinical relevance(Brasme et al, 2012;Flemming et al, 2017;Iversen, Antonsen, Laurberg, & Lautrup, 2009;Nagle et al, 2011;Polissar, Sim, & Francis, 1981;Porta, Gallen, Malats, & Planas, 1991;Rupassara, Ponnusamy, Withanage, & Milewski, 2006;Sainsbury, Johnston, & Haward, 1999). Instead of questioning their study design, many have ignored statistically significant reverse effects and claimed that the time duration of both diagnostic and treatment processes is too short to have any clinical relevance(Brasme et al, 2012;Flemming et al, 2017;Iversen, Antonsen, Laurberg, & Lautrup, 2009;Nagle et al, 2011;Polissar, Sim, & Francis, 1981;Porta, Gallen, Malats, & Planas, 1991;Rupassara, Ponnusamy, Withanage, & Milewski, 2006;Sainsbury, Johnston, & Haward, 1999).…”