Related Experiment Video
Updated: Oct 18, 2025
Intracranial Orthotopic Allografting of Medulloblastoma Cells in Immunocompromised Mice
Published on: October 3, 2010
Molecular Subgroup Is the Strongest Predictor of Medulloblastoma Outcome in a Resource-Limited Country
Nisreen Amayiri1, Maisa Swaidan2, Ahmed Ibrahimi3
1Division of Pediatric Hematology/Oncology, King Hussein Cancer Center, Amman, Jordan.
Insights
Medulloblastoma molecular subgroups SHH and group 4 show excellent survival in Jordan, while group 3 has poor outcomes. Adhering to treatment protocols and minimizing radiotherapy delays are crucial for better survival in low-income settings.
Area of Science:
- Pediatric Oncology
- Neuro-Oncology
- Molecular Subtyping
Background:
- Medulloblastoma comprises four distinct molecular subgroups: WNT, SHH, group 3, and group 4.
- Clinical implications of these subgroups in low- to middle-income countries (LMICs) are underreported.
Purpose of the Study:
- To investigate the clinical implications of medulloblastoma molecular subgroups in a Jordanian cohort.
- To correlate subgroup characteristics with clinical and radiological findings and patient outcomes in an LMIC setting.
Main Methods:
- An institutional cohort of 88 children (3-18 years) diagnosed with medulloblastoma between 2003 and 2016 in Jordan was analyzed.
- Tumor subgrouping was performed using NanoString technology.
- Clinical data, including radiotherapy timing and chemotherapy, were correlated with progression-free survival (PFS) and overall survival.
Main Results:
- SHH (25%) and group 4 (32%) tumors showed excellent PFS (83.4% and 87.0%).
- Group 3 tumors (24%) had dismal PFS (44.9%), and WNT tumors (19%) had less-than expected PFS (70.5%).
- Metastasis and radiotherapy delays (>49 days) significantly impacted overall survival (P=0.011).
Conclusions:
- SHH and group 4 medulloblastoma patients in Jordan achieved survival rates comparable to high-income countries.
- Optimizing treatment compliance and reducing radiotherapy delays are critical for improving outcomes in LMICs.
- Subgroup-specific treatment protocols should be considered for resource-limited settings.
Purpose:
Medulloblastoma is composed of four clinically and prognostically distinct molecular subgroups (WNT, SHH, group 3, and group 4). However, the clinical implications of these subgroups in the context of the unique challenges of low- to middle-income countries are rarely reported.
Methods:
We assembled an institutional cohort of children (3-18 years) diagnosed with medulloblastoma and treated in Jordan between 2003 and 2016. Tumors were subgrouped by NanoString and correlated with clinical and radiologic characteristics.
Results:
Eighty-eight patients were identified (63% male); median age was 6.9 years (interquartile range 4.8-9.2) and median symptom duration was 6 weeks (interquartile range 4-11). Radiotherapy was implemented as standard-risk in 41 patients (47%) and high-risk in 47 patients (53%). Subgrouping revealed 17 WNT (19%), 22 SHH (25%), 21 group 3 (24%), and 28 group 4 tumors (32%). Median time between craniotomy and radiotherapy was 45 days (17-155); 44% of them > 49 days. Median duration of radiotherapy was 44 days (36-74). Seventy-two patients (82%) received chemotherapy afterward. With a median follow-up of 4.6 years (0.2-14.9), 5-year progression-free survival (PFS) and overall survival were 73.5% and 69.4%, respectively, with no statistically significant survival difference between standard-risk and high-risk patients. Metastasis was significant for overall survival (P = .011). Patients with SHH and group 4 tumors had very good PFS (83.4% and 87.0%, respectively) and those with group 3 tumors had dismal outcomes (PFS 44.9%), whereas WNT tumors had less-than expected PFS (70.5%). PFS was statistically significant in patients with nonmetastatic tumors receiving radiotherapy ≤ 49 days (P = .011), particularly group 3 tumors.
Conclusion:
Patients with SHH and group 4 medulloblastoma had excellent survival comparable with high-income countries. Compliance with treatment protocols and avoiding radiotherapy delays are important in achieving adequate survival in low- to middle-income country settings. Subgroup-driven treatment protocols should be considered in countries with limited resources.
