Epidemiological characteristics and survival outcomes of children with
medulloblastoma treated at the National Cancer Institute (INCA) in Rio
de Janeiro, Brazil
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.