title: Clinical characteristics and abandonment and outcome of treatment in 67 Chinese children with medulloblastoma.
abstract: OBJECT The purpose of this study was to explore the clinical features and outcome of medulloblastoma in Chinese children. The authors analyze the reasons that treatment is abandoned and attempt to provide evidence-based recommendations for improving the prognosis of medulloblastoma in this population. METHODS A total of 67 pediatric cases of newly diagnosed medulloblastoma were included in this study. All of the children were treated at Xinhua Hospital between January 2007 and June 2013. The authors retrospectively analyzed the clinical data, treatment modalities, and outcome. The male-to-female ratio was 2:1, and the patients' median age at diagnosis was 51.96 months (range 3.96-168.24 months). The median duration of follow-up was 32 months (range 3-70 months). RESULTS At the most recent follow-up date, 31 patients (46%) were alive, 30 (45%) had died, and 6 (9%) had been lost to follow-up. The estimated 3-year overall survival and progression-free survival, based on Kaplan-Meier analysis, were 55.1% ± 6.4% and 45.6% ± 6.7%, respectively. Univariate analysis showed that standard-risk group (p = 0.009), postoperative radiotherapy (RT) combined with chemotherapy (p < 0.001), older age (≥ 3 years) at diagnosis (p = 0.010), gross-total resection (p = 0.012), annual family income higher than $3000 (p = 0.033), and living in urban areas (p = 0.008) were favorable prognostic factors. Multivariate analysis revealed that postoperative RT combined with chemotherapy was an independent prognostic factor (p < 0.001). The treatment abandonment rate in this cohort was 31% (21 of 67 cases). CONCLUSIONS There was a large gap between the outcome of medulloblastoma in Chinese children and the outcome in Western children. Based on our data, treatment abandonment was the major cause of therapeutic failure. Parents' misunderstanding of medulloblastoma played a major role in abandonment, followed by financial and transportation difficulties. Establishment of multidisciplinary treatment teams could improve the prognosis of medulloblastoma in Chinese children.
authors.affiliation: Departments of 1 Pediatric Hematology/Oncology.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.affiliation: Departments of 1 Pediatric Hematology/Oncology.
authors.forename: Xiao-Jun
authors.initials: XJ
authors.lastname: Yuan
authors.affiliation: Oncological Radiotherapy, and.
authors.forename: Ma-Wei
authors.initials: MW
authors.lastname: Jiang
authors.affiliation: Pathology, Xin Hua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Li-Feng
authors.initials: LF
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D002528:Cerebellar Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D011379:Prognosis; D017211:Treatment Failure; D016896:Treatment Outcome
keywords: Chinese children; GTR = gross-total resection; OS = overall survival; PFS = progression-free survival; RT = radiotherapy; STR = subtotal resection; clinical characteristic; medulloblastoma; oncology; prognosis