title: Long time to diagnosis of medulloblastoma in children is not associated with decreased survival or with worse neurological outcome.
abstract: BACKGROUND
  The long time to diagnosis of medulloblastoma, one of the most frequent brain tumors in children, is the source of painful remorse and sometimes lawsuits. We analyzed its consequences for tumor stage, survival, and sequelae.
  
  
  METHODS
  This retrospective population-based cohort study included all cases of pediatric medulloblastoma from a region of France between 1990 and 2005. We collected the demographic, clinical, and tumor data and analyzed the relations between the interval from symptom onset until diagnosis, initial disease stage, survival, and neuropsychological and neurological outcome.
  
  
  RESULTS
  The median interval from symptom onset until diagnosis for the 166 cases was 65 days (interquartile range 31-121, range 3-457). A long interval (defined as longer than the median) was associated with a lower frequency of metastasis in the univariate and multivariate analyses and with a larger tumor volume, desmoplastic histology, and longer survival in the univariate analysis, but not after adjustment for confounding factors. The time to diagnosis was significantly associated with IQ score among survivors. No significant relation was found between the time to diagnosis and neurological disability. In the 62 patients with metastases, a long prediagnosis interval was associated with a higher T stage, infiltration of the fourth ventricle floor, and incomplete surgical resection; it nonetheless did not influence survival significantly in this subgroup.
  
  
  CONCLUSIONS
  We found complex and often inverse relations between time to diagnosis of medulloblastoma in children and initial severity factors, survival, and neuropsychological and neurological outcome. This interval appears due more to the nature of the tumor and its progression than to parental or medical factors. These conclusions should be taken into account in the information provided to parents and in expert assessments produced for malpractice claims.
authors.affiliation: Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France. jfbrasme@gmail.com
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Brasme
authors.forename: Jacques
authors.initials: J
authors.lastname: Grill
authors.forename: Francois
authors.initials: F
authors.lastname: Doz
authors.forename: Brigitte
authors.initials: B
authors.lastname: Lacour
authors.forename: Dominique
authors.initials: D
authors.lastname: Valteau-Couanet
authors.forename: Stephan
authors.initials: S
authors.lastname: Gaillard
authors.forename: Olivier
authors.initials: O
authors.lastname: Delalande
authors.forename: Nozar
authors.initials: N
authors.lastname: Aghakhani
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Puget
authors.forename: Martin
authors.initials: M
authors.lastname: Chalumeau
mesh_terms: D002528:Cerebellar Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D057210:Delayed Diagnosis; D006801:Humans; D007361:Intelligence Tests; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008318:Malpractice; D008527:Medulloblastoma / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome; D047368:Tumor Burden