Overcoming Logistical Delays and Resource Constraints: Achieving Complete Response in High-Risk Medulloblastoma with Delayed Metastatic Progression at a Newly Established Secondary Cancer Center

Vollständiger Abstract

Worum geht es in dieser Arbeit?

Introduction: High-risk Medulloblastoma (MB) requires time-critical, multimodal therapy. This report details the management of a high-risk MB case where critical logistical barriers necessitated treatment adaptation in a newly established, resource-limited secondary center. Case Presentation: A 12-year-old female with Anaplastic/Large Cell MB suffered a critical two-month delay in initiating adjuvant therapy due to referral failures. This delay resulted in disease progression and confirmed M+ spinal drop metastases. The patient underwent second surgery, followed by intensive therapy. Intervention and Adaptation: Initial resource deficits (radiotherapy immobilization equipment and skilled radiation therapists) were overcome through rapid inter-institutional collaboration. Due to institutional inpatient bed restrictions, a modified outpatient chemotherapy protocol (Carboplatin, Etoposide, Cyclophosphamide, Vincristine) was successfully delivered. While the patient experienced significant hematologic toxicity (requiring transfusions and multiple hospitalizations for febrile neutropenia), the regimen was completed without life-threatening infections. Conclusion: The patient achieved a Radiological Complete Response (CR) at all sites and demonstrated remarkable functional recovery (independent mobility, improved speech). This case validates the feasibility of safely delivering high-quality, intensive pediatric neuro-oncology protocols in a resource-limited setting through thoughtful protocol adaptation and robust multi-institutional collaboration.