ABSTRACT
BACKGROUND: Medulloblastoma (MB), the most malignant brain tumor of
childhood has survival outcomes exceeding 80% for standard risk and
60% for high risk patients in high-income countries (HIC). These
results have not been replicated in low-to-middle income countries
(LMIC), where 80% of children with cancer live.
METHODS: Retrospective review of 114 children (3-18 years) diagnosed
with MB from 1997 to 2016 at INCA. Data on patients, disease
characteristics and treatment information were retrieved from the charts
and summarized descriptively. Overall survival (OS) and event-free
survival (EFS) were calculated using the Kaplan-Meier Method.
RESULTS: The male/female ratio was 1.32 and the median age at diagnosis
was 8.2 years. Headache (83%) and nausea/vomiting (78%) were the most
common presenting symptoms. Overall survival (5y) was 59,1% and EFS
(5y) was 58,4%. The OS for standard-risk patients was 69% and 53% for
high-risk patients. Forty-five patients (35%) had metastatic disease at
admission. Lower maternal education correlated with lower OS (71.3%versus 49% p=0.25). Patients who lived >40km from
INCA fared better (OS= 68.2% versus 51.1% p=0.032). Almost 20%
of families lived below the Brazilian minimum wage.
CONCLUSIONS: The epidemiological characteristics of this series possibly
explain the differences in survival that medulloblastoma patients have
in Brazil. Issues related to limited health care resources, poverty,
delayed diagnosis, treatment abandonment, and malnutrition are reflected
in inferior survival outcomes when compared to high-income countries.
Despite the difficulties encountered in an upper-middle income country,
it was possible to delivertreatment with good results.