Medulloblastoma With Extensive Nodularity:Tailored Therapy in a Low-resource Setting

Aristizabal, Paula; Burns, Luke; Rivera-Gómez, Rebeca; Levy, Michael L.; Roberts, William; Crawford, John R.

doi:10.1097/mph.0000000000000798

Cited by 5 publications

(6 citation statements)

References 18 publications

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“…23,24 GTR has an important role in improving the prognosis of patients with certain CNSTs, particularly medulloblastoma and low-grade glioma. 7,11,37,[39][40][41][42] Only children who underwent resection at RCHSD achieved GTR compared with patients who underwent surgery exclusively at HGT. This highlights the critical role of surgical expertise and adequate infrastructure and equipment to effectively cure CNSTs.…”

Section: Discussionmentioning

confidence: 99%

“…Chemotherapy protocols were collaboratively developed by RCHSD and HGT teams on the basis of published recommendations for LMICs and were tailored to the local resources and availability of chemotherapy agents. 11,23,[35][36][37] Surgery services at RCHSD were provided as in kind. HGT leadership and the local foundation, Patronato HGT, committed to fund personnel, equipment, medications, supplies, and operational costs.…”

Section: Capacity Building: Targeted Training and Infrastructure Enha...mentioning

confidence: 99%

“…This includes timely access to sophisticated neurosurgical and intensive care with experienced neuro-oncologists, pediatric neurosurgeons, neuro-radiologists, radiation oncologists, neuro-pathologists, and intensivists, which is frequently absent in LMICs. 10,11 To deliver effective therapy for children with CNSTs in Mexico, we established the Cross-Border Neuro-Oncology Program (CBNP) in 2010 between the Hospital General, Tijuana (HGT), and Rady Children's Hospital, San Diego (RCHSD), located 20 miles from HGT.…”

Section: Introductionmentioning

confidence: 99%

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Improving Pediatric Neuro-Oncology Survival Disparities in the United States–Mexico Border Region: A Cross-Border Initiative Between San Diego, California, and Tijuana, Mexico

Aristizabal

Burns

Kumar

et al. 2020

JCO Global Oncology

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PURPOSE Treatment of children with CNS tumors (CNSTs) demands a complex, interdisciplinary approach that is rarely available in low- and middle-income countries. We established the Cross-Border Neuro-Oncology Program (CBNP) between Rady Children’s Hospital, San Diego (RCHSD), and Hospital General, Tijuana (HGT), Mexico, to provide access to neuro-oncology care, including neurosurgic services, for children with CNSTs diagnosed at HGT. Our purpose was to assess the feasibility of the CBNP across the United States-Mexico border and improve survival for children with CNSTs at HGT by implementing the CBNP. PATIENTS AND METHODS We prospectively assessed clinicopathologic profiles, the extent of resection, progression-free survival, and overall survival (OS) in children with CNSTs at HGT from 2010 to 2017. RESULTS Sixty patients with CNSTs participated in the CBNP during the study period. The most common diagnoses were low-grade glioma (24.5%) and medulloblastoma (22.4%). Of patients who were eligible for surgery, 49 underwent resection at RCHSD and returned to HGT for collaborative management. Gross total resection was achieved in 78% of cases at RCHSD compared with 0% at HGT ( P < .001) and was a predictor of 5-year OS (hazard ratio, 0.250; 95% CI, 0.067 to 0.934; P = .024). Five-year OS improved from 0% before 2010 to 52% in 2017. CONCLUSION The CBNP facilitated access to complex neuro-oncology care for underserved children in Mexico through binational exchanges of resources and expertise. Survival for patients in the CBNP dramatically improved. Gross total resection at RCHSD was associated with higher OS, highlighting the critical role of experienced neurosurgeons in the treatment of CNSTs. The CBNP model offers an attractive alternative for children with CNSTs in low- and middle-income countries who require complex neuro-oncology care, particularly those in close proximity to institutions in high-income countries with extensive neuro-oncology expertise.

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Section: Discussionmentioning

confidence: 99%

Section: Capacity Building: Targeted Training and Infrastructure Enha...mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Improving Pediatric Neuro-Oncology Survival Disparities in the United States–Mexico Border Region: A Cross-Border Initiative Between San Diego, California, and Tijuana, Mexico

Aristizabal

Burns

Kumar

et al. 2020

JCO Global Oncology

Self Cite

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“…Adjuvant therapy, including chemotherapy and radiotherapy, varies based on the pathologic and molecular classifications. 1 , 19 Chemotherapy is an important part of postoperative treatment of MB. In certain cases, chemotherapy could spare the patients from irradiation and the detrimental effects of irradiation on development.…”

Section: Discussionmentioning

confidence: 99%

Post-treatment maturation of medulloblastoma in children: two cases and a literature review

Zhou

et al. 2018

J Int Med Res

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We herein report two cases of post-treatment maturation of medulloblastoma (MB). We also conducted a literature review to summarize the clinical and pathologic features of MB maturation. From January 1992 to February 2017, 52 patients with MB underwent surgical resection followed by radiotherapy and chemotherapy. Tumor cell maturation was identified in two patients who underwent a second surgery. We conducted a systematic search of PubMed and identified six such cases. In both of our patients, the pathologic type was MB with extensive nodularity (MBEN). Both patients underwent radiotherapy and chemotherapy. The tumor differentiated to gangliocytoma in both patients. In the overall analysis that also included the six cases identified in the literature, the pathologic types were classic MB (n=1), desmoplastic/nodular MB (n=2), MBEN (n=3), and unclassified MB (n=2). MB differentiated into the following types: gangliocytoma (n=2), ganglioglioma (n=1), melanocyte (n=1), neuronal differentiation (n=2), and classic MB (n=1). Desmoplastic/nodular MB and MBEN can differentiate into less malignant cells types after radiotherapy and chemotherapy. Maturation of MB may be affected radiotherapy and chemotherapy.

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“…These trials have shown promising results and are pioneering the future in avoiding the long-term cognitive deficits associated with radiotherapy. Avoiding the need for radiotherapy is also beneficial to patients in resource-limited areas that are unable to offer these types of advanced treatment modalities [27].…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Analysis of the Demographics, Treatment, and Survival Outcomes of Patients with Desmoplastic Nodular Medulloblastoma Using the Surveillance, Epidemiology, and End Results (SEER) Database

Gendreau

Gupta

Giles

et al. 2020

Cureus

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Medulloblastoma is the most common malignant brain tumor in children younger than four years of age. Children diagnosed with desmoplastic nodular medulloblastoma (DNMB) have more favorable survival outcomes when compared to other subtypes of this disease and, to date, the demographics of DNMB have only been characterized by a few small clinical case series. Additionally, the current effort is being made at reducing radiotherapeutic modalities in this patient population to avoid the adverse effects associated with radiotherapy in children. Therefore, the goal of this study was to characterize the demographics, treatments, and survival outcomes of patients with DNMB using a large federal database. Methods The Surveillance, Epidemiology, and End Results database was queried to retrieve demographical, treatment, and survival data for patients diagnosed with DNMB. Statistical testing was performed with the R software stats package (R Foundation for Statistical Computing, Vienna, Austria). Student's t tests and analysis of variance tests were used to measure differences among survival rates. Results Data from 360 patients with DNMB were retrieved from 1975-2016. There was a higher prevalence of DNMB in children younger than four years of age (33% of all cases). Males had a higher prevalence than females (57%). There was a preponderance of diagnoses in white individuals (82% of all cases) and more diagnoses in the Pacific Coast region (49% of all cases). Distant metastases were present at initial diagnosis in 8.7%. Surgery was performed in almost all patients, and gross total resection was achieved in 77%. The overall rate of survival was 77.8% at five years; age, sex, race, and geographical region of diagnosis were not associated with differences in survival outcomes. Patients with no radiotherapy had a lower rate of 1 2 3 4 5 6

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Medulloblastoma With Extensive Nodularity:Tailored Therapy in a Low-resource Setting

Cited by 5 publications

References 18 publications

Improving Pediatric Neuro-Oncology Survival Disparities in the United States–Mexico Border Region: A Cross-Border Initiative Between San Diego, California, and Tijuana, Mexico

Improving Pediatric Neuro-Oncology Survival Disparities in the United States–Mexico Border Region: A Cross-Border Initiative Between San Diego, California, and Tijuana, Mexico

Post-treatment maturation of medulloblastoma in children: two cases and a literature review

A Retrospective Analysis of the Demographics, Treatment, and Survival Outcomes of Patients with Desmoplastic Nodular Medulloblastoma Using the Surveillance, Epidemiology, and End Results (SEER) Database

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