Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia
Purpose: Pediatric medulloblastoma (MB) treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographi...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
American Society of Clinical Oncology
2017-04-01
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| Series: | Journal of Global Oncology |
| Online Access: | http://ascopubs.org/doi/10.1200/JGO.2015.002659 |
| _version_ | 1818126903965384704 |
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| author | Revathi Rajagopal Sayyidatul Abd-Ghafar Dharmendra Ganesan Anita Zarina Bustam Mainudin Kum Thong Wong Norlisah Ramli Vida Jawin Su Han Lum Tsiao Yi Yap Eric Bouffet Ibrahim Qaddoumi Shekhar Krishnan Hany Ariffin Wan Ariffin Abdullah |
| author_facet | Revathi Rajagopal Sayyidatul Abd-Ghafar Dharmendra Ganesan Anita Zarina Bustam Mainudin Kum Thong Wong Norlisah Ramli Vida Jawin Su Han Lum Tsiao Yi Yap Eric Bouffet Ibrahim Qaddoumi Shekhar Krishnan Hany Ariffin Wan Ariffin Abdullah |
| author_sort | Revathi Rajagopal |
| collection | DOAJ |
| description | Purpose: Pediatric medulloblastoma (MB) treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographics and outcome of pediatric MB treated at the University Malaya Medical Center between January 1994 and December 2013 and describe the challenges encountered. Methods: Fifty-one patients with childhood MB were seen at University Malaya Medical Center. Data from 43 patients were analyzed; eight patients were excluded because their families refused treatment after surgery. Results: Headache and vomiting were the most common presenting symptoms, and the mean interval between symptom onset and diagnosis was 4 weeks. Fourteen patients presented with metastatic disease. Five-year progression-free survival (± SE) for patients ≥ 3 years old was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) in the high-risk group and 68.6% ± 18.6% (95% CI, 40.3% to 100%) in the average-risk group, and 5-year overall survival (± SE) in these two groups was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) and 58.3% ± 18.6% (95% CI, 31.3% to 100%), respectively. Children younger than 3 years old had 5-year progression-free and overall survival rates (± SE) of 47.6% ± 12.1% (95% CI, 28.9% to 78.4%) and 45.6% ± 11.7% (95% CI, 27.6% to 75.5%), respectively. Time to relapse ranged from 4 to 132 months. Most patients who experienced relapse died within 1 year. Febrile neutropenia, hearing loss, and endocrinopathy were the most common treatment-related complications. Conclusion: The survival rate of childhood MB in Malaysia is inferior to that usually reported in the literature. We postulate that the following factors contribute to this difference: lack of a multidisciplinary neuro-oncology team, limited health care facilities, inconsistent risk assessment, insufficient data in the National Cancer Registry and pathology reports, inadequate long-term follow-up, and cultural beliefs leading to treatment abandonment. |
| first_indexed | 2024-12-11T07:08:52Z |
| format | Article |
| id | doaj.art-481b0588336245e58c3e6d8f797d8cda |
| institution | Directory Open Access Journal |
| issn | 2378-9506 |
| language | English |
| last_indexed | 2024-12-11T07:08:52Z |
| publishDate | 2017-04-01 |
| publisher | American Society of Clinical Oncology |
| record_format | Article |
| series | Journal of Global Oncology |
| spelling | doaj.art-481b0588336245e58c3e6d8f797d8cda2022-12-22T01:16:24ZengAmerican Society of Clinical OncologyJournal of Global Oncology2378-95062017-04-013214315610.1200/JGO.2015.0026597Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in MalaysiaRevathi RajagopalSayyidatul Abd-GhafarDharmendra GanesanAnita Zarina Bustam MainudinKum Thong WongNorlisah RamliVida JawinSu Han LumTsiao Yi YapEric BouffetIbrahim QaddoumiShekhar KrishnanHany AriffinWan Ariffin AbdullahPurpose: Pediatric medulloblastoma (MB) treatment has evolved over the past few decades; however, treating children in countries with limited resources remains challenging. Until now, the literature regarding childhood MB in Malaysia has been nonexistent. Our objectives were to review the demographics and outcome of pediatric MB treated at the University Malaya Medical Center between January 1994 and December 2013 and describe the challenges encountered. Methods: Fifty-one patients with childhood MB were seen at University Malaya Medical Center. Data from 43 patients were analyzed; eight patients were excluded because their families refused treatment after surgery. Results: Headache and vomiting were the most common presenting symptoms, and the mean interval between symptom onset and diagnosis was 4 weeks. Fourteen patients presented with metastatic disease. Five-year progression-free survival (± SE) for patients ≥ 3 years old was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) in the high-risk group and 68.6% ± 18.6% (95% CI, 40.3% to 100%) in the average-risk group, and 5-year overall survival (± SE) in these two groups was 41.7% ± 14.2% (95% CI, 21.3% to 81.4%) and 58.3% ± 18.6% (95% CI, 31.3% to 100%), respectively. Children younger than 3 years old had 5-year progression-free and overall survival rates (± SE) of 47.6% ± 12.1% (95% CI, 28.9% to 78.4%) and 45.6% ± 11.7% (95% CI, 27.6% to 75.5%), respectively. Time to relapse ranged from 4 to 132 months. Most patients who experienced relapse died within 1 year. Febrile neutropenia, hearing loss, and endocrinopathy were the most common treatment-related complications. Conclusion: The survival rate of childhood MB in Malaysia is inferior to that usually reported in the literature. We postulate that the following factors contribute to this difference: lack of a multidisciplinary neuro-oncology team, limited health care facilities, inconsistent risk assessment, insufficient data in the National Cancer Registry and pathology reports, inadequate long-term follow-up, and cultural beliefs leading to treatment abandonment.http://ascopubs.org/doi/10.1200/JGO.2015.002659 |
| spellingShingle | Revathi Rajagopal Sayyidatul Abd-Ghafar Dharmendra Ganesan Anita Zarina Bustam Mainudin Kum Thong Wong Norlisah Ramli Vida Jawin Su Han Lum Tsiao Yi Yap Eric Bouffet Ibrahim Qaddoumi Shekhar Krishnan Hany Ariffin Wan Ariffin Abdullah Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia Journal of Global Oncology |
| title | Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia |
| title_full | Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia |
| title_fullStr | Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia |
| title_full_unstemmed | Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia |
| title_short | Challenges of Treating Childhood Medulloblastoma in a Country With Limited Resources: 20 Years of Experience at a Single Tertiary Center in Malaysia |
| title_sort | challenges of treating childhood medulloblastoma in a country with limited resources 20 years of experience at a single tertiary center in malaysia |
| url | http://ascopubs.org/doi/10.1200/JGO.2015.002659 |
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