NCOG-02. Conquering Infant Medulloblastoma in Resource-Limited Settings: Challenges, Opportunities, and Treatment Outcomes

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.