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Epidemiological characteristics and survival outcomes of children with medulloblastoma treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil
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  • Gabriela Oigman,
  • Diana Osorio,
  • Sima Ferman,
  • Joseph Stanek,
  • Antonio Aversa,
  • Marcio Christiani,
  • Denise Magalhaes,
  • Jonathan L. Finlay,
  • Denizar Vianna
Gabriela Oigman
Instituto Nacional de Cancer
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Diana Osorio
Nationwide Children's Hospital
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Sima Ferman
Instituto Nacional do Cancer
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Joseph Stanek
Nationwide Childrens Hospital
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Antonio Aversa
Instituto Nacional de Cancer
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Marcio Christiani
Instituto Nacional de Cancer
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Denise Magalhaes
Instituto Nacional de Cancer
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Jonathan L. Finlay
Ohio State University
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Denizar Vianna
Universidade do Estado do Rio de Janeiro
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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 deliver treatment with good results.

Peer review status:IN REVISION

19 Nov 2020Submission Checks Completed
19 Nov 2020Assigned to Editor
19 Nov 2020Submitted to Pediatric Blood & Cancer
23 Nov 2020Reviewer(s) Assigned
10 Dec 2020Review(s) Completed, Editorial Evaluation Pending
10 Dec 2020Editorial Decision: Revise Major
10 Mar 20211st Revision Received
10 Mar 2021Submission Checks Completed
10 Mar 2021Assigned to Editor
13 Mar 2021Reviewer(s) Assigned
27 Mar 2021Review(s) Completed, Editorial Evaluation Pending
29 Mar 2021Editorial Decision: Revise Minor