Abstract Background Timely diagnosis and multimodal therapy are essential in pediatric medulloblastoma. However, in low- and middle-income countries (LMICs), delays remain common due to low symptom awareness and health-system constraints. Evidence from Southeast Asia, including Indonesia, is limited. This study described diagnostic intervals, treatment patterns, and outcomes in children with medulloblastoma treated at a tertiary referral center in Indonesia. Methods We conducted a retrospective cohort study of children with medulloblastoma treated at Cipto Mangunkusumo Hospital, Jakarta (January 2023–December 2025). Demographic characteristics, presenting symptoms, histopathology, risk stratification, treatment modalities, diagnostic and treatment intervals, and outcomes were analyzed. Results Nineteen patients were included (63.2% male; mean age 7.9 ± 3.9 years). Common presenting symptoms were vomiting (32.4%), gait disturbance (23.5%), and headache (20.6%). Most patients were high-risk (94.7%). All underwent surgery, none achieved gross total resection. The median symptom-to-first consultation interval was 29 days (range 0–91), and symptom-to-imaging interval was 48 days (range 5–193). Delays were most pronounced during referral to specialized care (median 118 days; range 14–517). Among externally treated patients, imaging-to-surgery (median 70.5 days; IQR 12–148; n = 10) and surgery-to-radiotherapy (median 69.5 days; IQR 29–175; n = 6) were prolonged. At our center, imaging-to-surgery (median 16 days; IQR 6–91; n = 9) and surgery-to-radiotherapy intervals (median 32 days; IQR 22–113; n = 7) were shorter. Radiotherapy-to-chemotherapy initiation varied widely (median 40 days; IQR 30–347; n = 8). At last follow-up, 13 patients were alive, 3 had died, and 3 were lost to follow-up. Diagnostic and treatment intervals were not significantly associated with outcome (p 0.4 for all comparisons), although higher survival was observed among patients completing multimodality therapy. Conclusion Substantial diagnostic and treatment delays persist across the medulloblastoma care pathway in Indonesia, particularly during referral. Although not statistically associated with short-term outcomes in this small cohort, these delays highlight health-system bottlenecks relevant to LMIC pediatric neuro-oncology.
Saidah et al. (2026) studied this question.