Barriers and Clinical Factors Influencing Outcomes of Older Children
with Medulloblastoma in a Resource Limited Setting - Peru
Abstract
Background: Medulloblastoma is the most common malignant brain tumor in
children. We aim to determine the survival in children with
medulloblastoma at the Instituto Nacional de Enfermedades Neoplasicas
(INEN) between 1997 to 2013 in Peru, a low-middle income country at the
time of this analysis. We also describe the barriers and factors
influencing outcomes. Methods: Between 1997-2013, data from 103 children
older than 3 years with medulloblastoma were analyzed. Two groups of
treatment were identified 1997 – 2008 and 2009 – 2013. Event-free
(EFS) and overall survival (OS) were obtained using Kaplan-Meier method
and prognostic factors by univariate analysis (log-rank test). A survey
was created to identify factors that may have influenced outcome.
Results: Eighty-nine patients were included; median age was 8.1 years
(range: 2.9-13.9 years). Surgical resection was complete in 39 patients.
The five-year OS was 63% (95% CI: 53 – 74%) while EFS was 59% (95%
CI: 49 – 71%). The variables adversely affecting survival were:
anaplastic histology [compared to desmoplastic; OS: HR=3.5, p=0.03;
EFS: HR=3.4, p=0.03], metastasis [OS: HR=3.4, p=0.01; EFS: HR=4.4,
p=0.003], and treatment post-2008 [OS: HR=2.5, p=0.01; EFS: HR=2.5;
p=0.01]. Conclusions: Outcomes for Medulloblastoma at INEN are low
compared with high- income countries (HIC). Univariate analysis
demonstrated that histological sub-type, metastasis at diagnosis, and
treatment post-2008 all negatively affected outcomes in our study. The
importance of multidisciplinary teamwork in the care of children with
pediatric brain tumors as well as partnerships with loco-regional groups
and colleagues in HIC is vastly beneficial.