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Influence of a child's sex on medulloblastoma outcome
M D Weil1, K Lamborn, M S Edwards
1Department of Radiation Oncology, University of California, San Francisco, USA. mweil@brown.uhcolorado.edu
Context:
Aggressive treatment of medulloblastoma, the most common pediatric brain tumor, has not improved survival. Identifying better prognostic indicators may warrant less morbid therapy.
Objective:
To investigate the role of sex on outcome of medulloblastoma.
Design:
Retrospective study of significant factors for survival with a median follow-up of 82 months.
Setting:
University medical center.
Patients:
A total of 109 consecutive, pediatric patients treated for primary medulloblastoma from 1970 to 1995 with surgery and postoperative radiotherapy and, after 1979, chemotherapy.
Main Outcome Measures:
Factors independently associated with survival.
Results:
The final multivariate model predicting improved survival included sex (hazard ratio, 0.52; 95% confidence interval [CI], 0.29-0.92; P=.03; favoring female), metastases at presentation (hazard ratio, 2.01; 95% CI, 1.14-3.52; P=.02), and extent of surgical resection (hazard ratio, 0.60; 95% CI, 0.34-1.04; P=.07; favoring greater resection). The overall, 5-year freedom from progression was 40% and survival was 49%. Radiotherapy dose (P=.72), and chemotherapy (P=.90) did not significantly affect a disease outcome.
Conclusions:
The sex of the child was an important predictor for survival of medulloblastoma; girls had a much better outcome. The difference in survival between sexes should be evaluated in prospective, clinical trials.