Sequential improvement in paediatric medulloblastoma outcomes in a low-and-middle-income country setting over three decades

SA Journal of Oncology

Field Value
Title Sequential improvement in paediatric medulloblastoma outcomes in a low-and-middle-income country setting over three decades
Creator Riedemann, Johann Figaji, Anthony Davidson, Alan Stannard, Clare Pillay, Komala Kilborn, Tracy Parkes, Jeannette
Subject Paediatric Oncology Paediatric brain tumours; medulloblastoma; radiotherapy; 3D conformal radiotherapy; craniospinal irradiation; chemotherapy; paediatric neurosurgery; leptomeningeal spread; cerebrospinal fluid; paediatric oncology; low-and-middle-income countries; Paediatr
Description Background: Medulloblastoma (MB) is the commonest malignant brain tumour of childhood. Accurate clinical data on paediatric MB in the low-and-middle-income countries (LMIC) setting are lacking. Sequential improvements in outcomes seen in high-income countries are yet to be reflected in LMICs.Aim: The aim of this study was quantification of paediatric MB outcomes in the LMIC setting over three decades of advances in multidisciplinary intervention.Setting: Cape Town, South Africa.Methods: This was a retrospective study of 136 children with MB diagnosed between 1985 and 2015. The modified Chang criteria were used for risk stratification. The primary objective of this study was overall survival (OS), quantified by analysis of epidemiological, clinical and pathological data.Results: OS improved significantly during the most recent decade (2005–2015) when compared with the preceding two decades (1985–1995 and 1995–2005). Despite reduced-dose craniospinal irradiation (CSI) for standard risk cases, OS was significantly greater than during the preceding two decades. High-risk disease was identified in 71.4% of cases and was associated with significantly inferior OS compared with standard-risk cases. Improved OS was positively correlated with the therapeutic era, three-dimensional (3D) conformal radiotherapy technique, older age at diagnosis, classic and desmoplastic histology, extent of resection and absence of leptomeningeal spread on imaging.Conclusion: Advances in multidisciplinary management of MB in our combined service are associated with improved survival. Access to improved imaging modalities, advances in surgical techniques, increased number of patients receiving risk-adapted combination chemotherapy or radiotherapy, as well as CSI using a linear accelerator with 3D planning, are considered as contributing factors.
Publisher AOSIS
Contributor None
Date 2021-05-26
Type info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion — Retrospective / historical
Format text/html application/epub+zip text/xml application/pdf
Identifier 10.4102/sajo.v5i0.174
Source South African Journal of Oncology; Vol 5 (2021); 11 pages 2523-0646 2518-8704
Language eng
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Coverage South Africa; LMIC 1985 - 2015 Children
Rights Copyright (c) 2021 Johann Riedemann, Anthony Figaji, Alan Davidson, Komala Pillay, Tracy Kilborn, Jeannette Parkes