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Survival among children with medulloblastoma in Greece: gains from transition to chemotherapy and socio-economic differentials.

Abstract
The objective of this study was to quantify improvements in survival due to chemotherapy among children with medulloblastoma treated during the last three decades at a university unit in Greece, compare these gains with figures derived from a specialized unit in the United States and explore the role of extrinsic factors affecting survival. The records of all children with medulloblastoma (n=50) treated at the University Childhood Oncology Unit in Athens, Greece during the period 1973-2003 were reviewed. The role on survival of socio-demographic factors was studied by modeling the data through Cox's proportional-hazards regression, controlling for the mode of treatment (chemotherapy, yes vs. no), whereas survival of children with medulloblastoma treated in Greece was compared with that of 76 children treated in a specialized center in the United States during a respective period. After adjustment for demographic factors, children with medulloblastoma who received adjuvant therapy in Greece had an approximately four times higher instantaneous rate of remaining alive than those who did not (P=0.05). The 5-year survival of children with medulloblastoma treated at specialized medical centers in Greece and the United States was 66 and 63%, respectively. Despite the comparable figure with that of an acceptable standard, however, there was a suggestion (P=0.07) that a rural place of residence in Greece is a poor prognostic indicator. Assuming inherently similar age of occurrence in urban and rural areas, children from rural areas in this study had a more advanced age at diagnosis than those residing in urban Greece (mean age: 7.9 vs. 6.6 years) with a 5-year survival of 57 and 73%, respectively. As expected, incorporation of adjuvant chemotherapy in the treatment of Greek children with medulloblastoma has yielded remarkable improvement in 5-year survival, comparable to that of technologically advanced countries. On the contrary, children residing in rural areas of the country seem to enjoy less favorable prognosis, possibly owing to delays in diagnosis or limited access to optimal treatment facilities.
AuthorsMaria Moschovi, Theodora Stavrou, Nick Dessypris, Ilias Skalkidis, Dimitris Karalis, Gregory H Reaman, Alisa M Goldstein, Neophytos Prodromou, Fotini Tzortzatou-Stathopoulou, Eleni Th Petridou
JournalEuropean journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP) (Eur J Cancer Prev) Vol. 16 Issue 5 Pg. 460-5 (Oct 2007) ISSN: 0959-8278 [Print] England
PMID17923818 (Publication Type: Journal Article, Research Support, N.I.H., Intramural, Research Support, Non-U.S. Gov't)
Topics
  • Adolescent
  • Cerebellar Neoplasms (drug therapy, mortality)
  • Child
  • Child, Preschool
  • Female
  • Greece (epidemiology)
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Medulloblastoma (drug therapy, mortality)
  • Socioeconomic Factors

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