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Barriers and Clinical Factors Influencing Outcomes of Older Children with Medulloblastoma in a Resource Limited Setting - Peru
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  • Rosdali Diaz Coronado,
  • James Reinecke,
  • Joseph Stanek,
  • Jonathan Finlay,
  • Eddy Hernandez,
  • Sharon Chavez,
  • Yesenia Miranda Tunque,
  • Adela Heredia Zelaya ,
  • Sandro Casavilca Zambrano,
  • Pamela Garcia-Corrochano Medina,
  • Luis Ojeda Medina,
  • Enrique Orrego Puelles,
  • Ebert Torres Malca,
  • Raymundo Sernaque Quintana,
  • William Quispe Valverde,
  • Juan Garcia Leon,
  • Diana Osorio
Rosdali Diaz Coronado
Instituto Nacional de Enfermedades Neoplasicas
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James Reinecke
Nationwide Children's Hospital Department of Pediatric Hematology Oncology and Bone Marrow Transplants
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Joseph Stanek
Nationwide Children's Hospital Department of Pediatric Hematology Oncology and Bone Marrow Transplants
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Jonathan Finlay
Nationwide Children's Hospital
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Eddy Hernandez
Instituto Nacional de Enfermedades Neoplasicas
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Sharon Chavez
Instituto Nacional de Enfermedades Neoplasicas
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Yesenia Miranda Tunque
Instituto Nacional de Enfermedades Neoplasicas
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Adela Heredia Zelaya
Instituto Nacional de Enfermedades Neoplasicas
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Sandro Casavilca Zambrano
Instituto Nacional de Enfermedades Neoplasicas
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Pamela Garcia-Corrochano Medina
Instituto Nacional de Enfermedades Neoplasicas
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Luis Ojeda Medina
Instituto Nacional de Enfermedades Neoplasicas
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Enrique Orrego Puelles
Instituto Nacional de Enfermedades Neoplasicas
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Ebert Torres Malca
Instituto Nacional de Enfermedades Neoplasicas
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Raymundo Sernaque Quintana
Instituto Nacional de Enfermedades Neoplasicas
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William Quispe Valverde
Instituto Nacional de Enfermedades Neoplasicas
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Juan Garcia Leon
Instituto Nacional de Enfermedades Neoplasicas
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Diana Osorio
Nationwide Children's Hospital
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Abstract

Background: Medulloblastoma is the most common malignant brain tumor in children. We aim to determine the survival in children with medulloblastoma at the Instituto Nacional de Enfermedades Neoplasicas (INEN) between 1997 to 2013 in Peru, a low-middle income country at the time of this analysis. We also describe the barriers and factors influencing outcomes. Methods: Between 1997-2013, data from 103 children older than 3 years with medulloblastoma were analyzed. Two groups of treatment were identified 1997 – 2008 and 2009 – 2013. Event-free (EFS) and overall survival (OS) were obtained using Kaplan-Meier method and prognostic factors by univariate analysis (log-rank test). A survey was created to identify factors that may have influenced outcome. Results: Eighty-nine patients were included; median age was 8.1 years (range: 2.9-13.9 years). Surgical resection was complete in 39 patients. The five-year OS was 63% (95% CI: 53 – 74%) while EFS was 59% (95% CI: 49 – 71%). The variables adversely affecting survival were: anaplastic histology [compared to desmoplastic; OS: HR=3.5, p=0.03; EFS: HR=3.4, p=0.03], metastasis [OS: HR=3.4, p=0.01; EFS: HR=4.4, p=0.003], and treatment post-2008 [OS: HR=2.5, p=0.01; EFS: HR=2.5; p=0.01]. Conclusions: Outcomes for Medulloblastoma at INEN are low compared with high- income countries (HIC). Univariate analysis demonstrated that histological sub-type, metastasis at diagnosis, and treatment post-2008 all negatively affected outcomes in our study. The importance of multidisciplinary teamwork in the care of children with pediatric brain tumors as well as partnerships with loco-regional groups and colleagues in HIC is vastly beneficial.

Peer review status:IN REVISION

12 Mar 2021Submitted to Pediatric Blood & Cancer
12 Mar 2021Assigned to Editor
12 Mar 2021Submission Checks Completed
24 Mar 2021Reviewer(s) Assigned
08 Apr 2021Review(s) Completed, Editorial Evaluation Pending
11 Apr 2021Editorial Decision: Revise Major