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

作者：Rosdali Díaz Coronado, James B. Reinecke, Joseph Stanek, Jonathan L. Finlay, Eddy Hernández, Sharon Chávez Paredes, Yesenia Miranda Tunque, Adela Heredia Zelaya, Sandro Casavilca‐Zambrano, Pamela García‐Corrochano Medina, Luis Ojeda Medina, Enrique Orrego Puelles, Ebert Torres Malca, Raymundo Sernaque Quintana, William Quispe Valverde, Juan Luis García León, Diana S. Osorio · 发表于：Pediatric Blood & Cancer · 年份：2022 · DOI：10.1002/pbc.29770 · 被引用次数：11 · 研究领域：Glioma Diagnosis and Treatment、Acute Lymphoblastic Leukemia research、Brain Metastases and Treatment

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 (compared to desmoplastic; OS: HR = 3.4, p = .03), metastasis (OS: HR = 3.5, p = .01; EFS: HR = 4.3, p = .004), delay in radiation therapy of 31-60 days (compared to ≤30 days; EFS: HR = 2.1, p = .04), and treatment 2009-2013 cohort (OS: HR = 2.2, p = .02; EFS: HR = 2.0, p = .03). CONCLUSIONS: Outcomes for medulloblastoma at INEN were low compared with HIC. Anaplastic subtype, metastasis at diagnosis, delay in radiation th...