NEURO-ONCOLOGY IN DEVELOPING COUNTRIES
Authors: M. Kamal, N. El-Khateeb, M. Awad, M. S. Zaghloul, S. Ahmed, M. El-Beltagy, H. Taha, A. Refaat, S. Abouelnaga, A. Refaat, M. Aggag, A. Youssef, M. Kamal, A. Gharieb, M. El-Beltagy, H. Taha, S. Ezzat, M. Kamal, O. Hassanain, S. Abouelnaga, H. Hussein, H. Hosny, M. Sabry, A. Samir, M. El-Beltagy, M. Kamal, M. S. Zaghloul, S. Abouelnaga, H. Taha, M. El Beltagy, M. Atteya, A. Moiyadi, P. Shetty, M. El-Shazly, A. El Masry, I. Quaddoumi, M. El-Fiki, S. Fadel, H. Xiong, J. Shao, J. Li, Z. Xu, K. Ezziane-Guechi, M. L. Atif, K. Bouzid, A. Bezzaoucha, M. Faranoush, A. Mehrvar, A. A. H. Asl, M. Tashvighi, R. R. Parsa, M. A. Fazeli, B. Sobuti, N. Mehrvar, J. Ali, R. Zangooei, M. Alebouyeh, P. Vossough, D. Perek, B. D. Baginska, M. Drogosiewicz, M. P. Polnik, W. Grajkowska, M. Roszkowski, G. Sobol, K. Musiol, J. Wachowiak, B. Kazmierczak, J. P. Pogorzelski, W. Mlynarski, B. Z. Szewczyk, M. Wysocki, E. Niedzielska, J. Kowalczyk, H. W. Slusarz, W. Balwierz, E. Z. Czepko, A. Szolkiewicz, P. Haddad, A. Zali, M. Tabatabaeefar, A. Nikoofar, H. H. Kharazi, M. Ghadyani, P. Fadavi, L. Mukhomorova, M. Faranoush, M. T. Nami, I. Botelho, F. Pedrosa, I. Qaddoumi, R. Ribeiro, A. Pedrosa, A. Hazim, G. Furtado, S. Serra, S. Procopio, A. Pillai, B. Mr, D. Panikar, M. Jarrar, M. Alharbi, T. Alharbi, R. Alsudairy, A. Alomari, K. Aljamaan, A. Alsultan, T. M. Hnin, A. Khaing, H. H. Tin, E. Ebeid, M. El Haddad, A. Mansour, A. El Haddad, I. Maza, L. Vasquez, K. Ordonez, G. Paredes, A. Yabar, E. Ugarte, J. Geronimo
Journal: Neuro-Oncology (2012)

Medulloblastoma (MB) accounts for approximately 20% of pediatric central nervous system neoplasms.Current standard management includes safe maximal surgical resection followed by craniospinal irradiation (CSI) with chemotherapeutic radiosensitization followed by adjuvant chemotherapy.The overall and event free survival rates depend upon many prognostic factors.PURPOSE: To investigate treatment outcome for newly diagnosed MB patients treated at the Children's Cancer Hospital Egypt 57357 (CCHE) and to determine the working prognostic factors.PATIENTS AND METHODS: This study included all patients; treated at the CCHE; with histologically confirmed MB between Jan, 2008, and Jan, 2011.The Median age of the 73 (49 males (67.1%); 24 females (32.9%)) patients was 7 years (range 3-17).The median follow up period was 16 months (range 1-41).Risk stratification based upon initial Chang's stage, degree of surgical resection and histopathology.All patients had surgical resection of the tumor.Seventy one patients (97.3%) received the allocated radiochemotherapy.One patient was lost follow up and one patient died before radiotherapy.Risk adapted treatment were performed via 2 treatment protocols (Standard and high risk).The 2 protocols differ in the dose of craniospinal irradiation and the chemotherapy regimen.RESULTS: The 3-year overall (OS) and event-free (EFS) survival differed significantly between average-risk and high-risk patients (p ¼ 0.024 and 0.003), with 77.8% and 82% OS and EFS for the average risk group respectively and 56.8 % and 50.5% OS and EFS for high-risk group respectively.The histopathology classification showed significant difference in both overall survivals: desmoplastic ¼ 75%, classic ¼ 71.6%, anaplastic ¼ 47.6%, (p ¼ 0.028) and event free survival: desmoplastic ¼ 75%, classic ¼ 68.9%, anaplastic ¼ 40.5%, (p ¼ 0.007).CONCLUSION: Preliminary results of risk adapted treatment for children suffering from medulloblastoma are encouraging and depending upon the clinical prognostic factors.Further follow up is needed to investigate further prognostic factors.DV-02.