Browsing by Author "Riedemann, Johann"

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    Sequential improvement in paediatric medulloblastoma outcomes in a low-and-middle-income country setting over three decades
    (2021) Riedemann, Johann; Parkes, Jeannette; Davidson, Alan; Figaji, Anthony
    Background: Medulloblastoma (MB) is the commonest malignant brain tumour of childhood. Accurate clinical data for paediatric MB in the LMIC setting is lacking. Sequential improvements in outcome seen in high income countries are yet to be reflected in LMIC. Aim: Quantification of paediatric MB outcomes in the LMIC setting over three decades of advances in multidisciplinary intervention. Setting: Cape Town, South Africa Methods: This was a retrospective study of 136 children with MB diagnosed between 1985 and 2015. Modified Chang criteria were used for risk stratification. The primary study objective was overall survival (OS), quantified by analysis of epidemiological, clinical and pathological data. Results: OS improved significantly during the most recent decade (2005-2015) when compared with the preceding two decades (1985-1995 and 1995-2005). Despite reduced dose craniospinal irradiation for standard risk cases, OS was significantly greater than during the preceding two decades. High-risk disease was identified in 71.4% of cases and was associated with significantly inferior OS compared with standard risk cases. Improved OS was positively correlated with therapeutic era, 3-D conformal radiotherapy technique, older age at diagnosis, classic and desmoplastic histology, extent of resection and absence of leptomeningeal spread on imaging. Conclusion: Advances in multidisciplinary management of MB in our combined service are associated with improved survival. Access to improved imaging modalities, advances in surgical techniques, increased number of patients receiving risk-adapted combination chemo- and/or radiotherapy as well as craniospinal irradiation using a linear accelerator with 3D planning, are considered as contributing factors.