Treatment Outcome and Prognostic Factors in Children with Medulloblastoma: A Retrospective Study of 53 Children in a Developing Country, Egypt

Medulloblastoma (MB) accounts for 20% of malignant brain tumours of childhood; however, only scarce data are available about paediatric medulloblastoma patients in developing countries. We aimed to assess the outcome and prognostic factors among Egyptian paediatric MB patients and compare them with high-income countries. This is a retrospective study that includes 53 eligible patients diagnosed with MB during the period from January 2008 to December 2013. Median age at diagnosis was 6 years. The majority of our patients (45) were high-risk patients (84.9%) (15% of them infantile <= 3 years), whereas 8 patients (15.1%) were standard-risk patients. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 54.6% and 74.8%, respectively. The presence of postoperative residual disease, spinal seeding, M staging, and completion of chemotherapy protocol made a significant difference in survival rate (p= 0.045 and p< 0.001; p= 0.021 and p< 0.001, respectively). There was no significant difference between patients presenting at ages younger or older than 3 years old regarding survival rate (5-year OS 50.0% versus 55.2%, respectively). At the end of this study, 29 patients (54.7%) were alive, 22 patients (41.5%) had died and two patients (3.8%) were lost to follow-up. Two patients relapsed after treatment. Patients with advanced stages and incomplete surgical resection had a poorer outcome. Coordinated, multidisciplinary paediatric neuro-oncology teams with better health care facilities, strong supportive care measures, and proper assessment of long-term morbidity are needed to improve the outcome of childhood MB patients in developing countries.