Childhood medulloblastoma in Morocco (middle-income country): therapeutic outcomes and survival

Background: Medulloblastoma is one of the most common malignant brain tumors of childhood, the management of medulloblastoma in low and middle-income countries (LMIC) is difficult and there is a lack of epidemiological data and mean features about this childhood pathology in Morocco.Methods: A retrospective study of 49 medulloblastoma cases diagnosed and treated at the university hospital IbnSina of Rabat, Morocco between 2010 and 2019.Results: At the diagnostic moment, the median age was 8 years old [interquartile range: 2, 16], with 27 male and 22 female patients, and the sex ratio was 1.23.The main reason for consultation was raised intracranial tension (headache, nausea, vomiting).Histologically, 22 cases were a classic type, 11 cases were nodular/desmoplastic, and only 2 cases were anaplastic/large cells.The median time from surgery to radiotherapy was 92 days [interquartile range: 31, 336].Radiotherapy was performed on 42 patients, comprising brain and spinal irradiation with doses of 24 Gy/36 Gy and posterior fossa boost with doses of 18 Gy/54 Gy.All patients received chemotherapy, which involved vincristine, cisplatin, etoposide, cyclophosphamide, and methotrexate.Patients treated with radiotherapy had the best overall survival rates after 5 years, with a mean survival of 87.9 months (P=0.005).Relapsed patients had the worst overall survival rates after 5 years, with a mean survival of 46.5 months, compared to no-relapsed patients (mean survival: 95.2 months, P=0.006).The time from surgery to radiotherapy had a significant statistical P value; we found that patients who started radiotherapy within 120 days had the best overall survival rates (mean survival: 99.4 months) compared to those who started more than 120 days (mean survival: 54.5 months, P=0.017). Conclusions:The results of this study regarding survival rates were encouraging and close to those found in others series.Finally, this retrospective study provides epidemiological data and the main features of this pathology in Morocco.However, we are still unable to perform a molecular classification, which is important to better understand the pathology and improve the survival rates.