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CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2019; 40(S 01): S13-S15
DOI: 10.4103/ijmpo.ijmpo_213_17
Original Article

Treatment Refusal and Abandonment Remain Major Concerns Despite Good Outcomes with Multi-Modality Management in Pediatric Medulloblastoma: Experience from a Cancer Center in Eastern India

Anirban Das
Departments of Paediatric Haematology-Oncology, Tata Medical Centre, Kolkata, West Bengal, India
,
Rimpa Basu Achari
Departments of Radiation Oncology, Tata Medical Centre, Kolkata, West Bengal, India
,
Lateef Zameer
Departments of Histopathology, Tata Medical Centre, Kolkata, West Bengal, India
,
Saugata Sen
Departments of Radiology, Tata Medical Centre, Kolkata, West Bengal, India
,
Shekhar Krishnan
Departments of Paediatric Haematology-Oncology, Tata Medical Centre, Kolkata, West Bengal, India
,
Arpita Bhattacharyya
Departments of Paediatric Haematology-Oncology, Tata Medical Centre, Kolkata, West Bengal, India
› Author Affiliations Financial support and sponsorship Nil.
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Abstract

Context: Survival in medulloblastoma, the most common pediatric brain tumor, has lagged behind in developing countries in comparison to the West. Aim: The aim of this study was to analyze the clinical profile and outcome in a cancer center in Eastern India. Methods: Twenty-nine children were retrospectively analyzed over 6 years. Results: Vomiting (79%), headache (69%), and unsteadiness (55%) were the presenting complaints. The majority (67%) had classical histology. High-risk (HR) disease (61.6%) exceeded average-risk (AR) (38.4%) disease in numbers. Treatment-refusal (27.6%) and abandonment (6.9%) were major concerns. Four-year EFS was 81% and 52%, excluding and including refusal/abandonment, respectively. There was no relapse/progression among AR patients. Four-year EFS in HR was 63%. Posterior fossa syndrome (37.5%), febrile neutropenia (29%), and ototoxicity (16.7%) were the main treatment-related morbidities. Implications: Following this audit, patient tracking to reduce abandonment, coordination to limit delay in postsurgical referral, developing strategies for molecular subgrouping, and reducing cumulative cisplatin exposure were measures adopted to improve outcome in the unit.

Keywords

Brain tumor - defaulter - ototoxicity - posterior fossa


Publication History

Article published online:
24 May 2021

© 2019. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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