Original Research

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

Johann Riedemann, Anthony Figaji, Alan Davidson, Clare Stannard, Komala Pillay, Tracy Kilborn, Jeannette Parkes
South African Journal of Oncology | Vol 5 | a174 | DOI: https://doi.org/10.4102/sajo.v5i0.174 | © 2021 Johann Riedemann, Anthony Figaji, Alan Davidson, Komala Pillay, Tracy Kilborn, Jeannette Parkes | This work is licensed under CC Attribution 4.0
Submitted: 28 February 2021 | Published: 26 May 2021

About the author(s)

Johann Riedemann, Department of Radiation Oncology, Faculty of Radiation Medicine, University of Cape Town, Cape Town, South Africa; and, Department of Radiation Oncology, Faculty of Radiation Medicine, Groote Schuur Hospital, Cape Town, South Africa
Anthony Figaji, Division of Neurosurgery and Neuroscience Institute, Faculty of Neurosurgery, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Alan Davidson, Department of Haematology Oncology Service, Faculty of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa
Clare Stannard, Department of Radiation Oncology, Faculty of Radiation Medicine, University of Cape Town, Cape Town, South Africa
Komala Pillay, Division of Anatomical Pathology, Anatomical Pathology Service, National Health Laboratory Services, South Africa; and, Faculty of Anatomical Pathology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Tracy Kilborn, Department of Radiology, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
Jeannette Parkes, Department of Radiation Oncology, Faculty of Radiation Medicine, University of Cape Town, Cape Town, South Africa; and, Department of Radiation Oncology, Faculty of Radiation Medicine, Groote Schuur Hospital, Cape Town, South Africa


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Abstract

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.


Keywords

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

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