NCOG-02. Conquering Infant Medulloblastoma in Resource-Limited Settings: Challenges, Opportunities, and Treatment Outcomes
Bibliographic record
Abstract
Abstract BACKGROUND Infant medulloblastoma presents a unique set of challenges, characterized by high recurrence rates and significant neurodevelopmental risks associated with craniospinal radiation (CSI). There is a scarcity of data on the outcomes achieved in LMICs, therefore we share our experience at KHCC/Jordan. METHODS Retrospective chart review was conducted for infants <5years old diagnosed with medulloblastoma (2010-2023). We extracted their clinical characteristics, tumor attributes, and treatment modalities. RESULTS Twenty-seven patients were identified (21 males,78%). The median age was 2years (0.5-4.3years). Twelve tumors (44%) underwent gross resection. Seventeen patients (63%) needed ventriculoperitoneal shunts. Seven (26%) developed postoperative complications. Fourteen tumors (52%) were metastatic. Ten tumors were of classic histology, eight desmoplastic, six anaplastic and three MBEN. Sixteen tumors (59%) were sub-grouped: SHH(fourteen), Group-3(two). Patients received various treatment protocols: HeadStart 1&2 (eleven), SKK-92 without IT-MTX (eight), ACNS0334 with single ASCT (six), and BBSFOP (two). Twenty-one patients were supposed to receive ASCT, however only thirteen did (three received SKK-92 due to financial constraints, two prematurely stopped therapy, two developed early tumor progression and one shifted to BBSFOP protocol due to chemotherapy toxicity). Seventeen patients (63%) are alive at a median of 5.2years (1.8-15.5years). Twelve patients are alive in CR1 without radiotherapy (5 without ASCT), two in CR2 after CSI-36Gy and one in CR3 after ASCT then CSI-23.4Gy. One patient lost to follow-up, and one is alive with disease at palliative care. Two patients developed secondary tumors, one died from thalamic high-grade glioma and one developed thyroid carcinoma. Two survivors needed cataract surgery, and four have hearing deficits. Ten survivors need hormonal supplements mostly growth hormone. CONCLUSIONS A subset of infants with medulloblastoma can be cured, even in LMICs, without ASCT or radiotherapy, however these treatments remain vital salvage options. Survivors require ongoing support to ensure optimal long-term quality of life.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".