ID #806 Impact of treatment on the survival in children with embryonal tumors in Honduras.

Background

Embryonal central nervous system (CNS) tumors are WHO grade 4 malignancies requiring intensive multimodal therapy. Standard treatment in older children includes maximal safe resection, craniospinal irradiation (CSI), and cisplatin-based chemotherapy, while infants are managed with radiation-sparing strategies using high-dose chemotherapy (HDCT) or intraventricular therapy. Outcomes in Latin America remain inferior to those reported in high-income countries; in Mexico, the reported 5-year event-free survival (EFS) for medulloblastoma (MB) is 52.6%. To date, no national data describing treatment outcomes for embryonal CNS tumors have been reported.

Methods

We performed a retrospective analysis of all pediatric embryonal CNS tumors diagnosed between 2019 and 2024 at Hospital Escuela, Honduras. OS and EFS were estimated using the Kaplan–Meier method, with comparisons across treatment modalities assessed using the log-rank test; hazard ratios (HRs) were evaluated and associations were calculated with correlation coefficients.

Results

Embryonal tumors accounted for 8.3% of cases. Histologic subtypes included MB not otherwise specified (NOS) (80%), atypical teratoid/rhabdoid tumor (ATRT) (10%), and embryonal tumor NOS (10%). Gross total resection was achieved in 30%. Chemotherapy was administered to 80% of patients, primarily using the AHOPCA-MB protocol in 75%; another 18.8% received 4 drugs metronomic therapy. Radiotherapy (RT) was delivered to 80% of patients, with 47.1% receiving focal RT only. CSI resulted in a significant 98% reduction in EFS risk when compared to focal RT (HR 0.020, p < 0.001, φ = -0.75). The 3-yr EFS and OS entire cohort were 51.1% and 73%, respectively. Subdivided by RT field, 3 yr EFS was 50% with CSI versus 31% with focal RT (p < 0.0001). Treatment abandonment occurred in 5% of cases.

Conclusions

Pediatric embryonal CNS tumor outcomes in Honduras are constrained by limited access to intensive therapies and the absence of standardized, age-adapted treatment protocols. Survival outcomes were poor among patients treated with focal RT alone. These findings are consistent with reports from other Latin American countries and highlight shared regional challenges, thus reinforcing the need to adopt and implement context-adapted protocols aligned with international standards to improve survival.

1. Salceda-Rivera, V., Tejocote-Romero, I., Osorio, D. S., Bellido-Magaña, R., López-Facundo, A., Anaya-Aguirre, S. E., Ortiz-Morales, D., Rivera-Luna, R., Reyes-Gutiérrez, E., Rivera-Gómez, R., Velasco-Hidalgo, L., Cortés-Alva, D., Lagarda-Arrechea, S., Arreguín-González, F. E., Benito-Reséndiz, A. E., Chávez-Gallegos, S., Pérez-Rivera, E., Gaytán-Fernández, G. J., León-Espitia, J. A., Domínguez-Sánchez, J., … González-Ramella, O. (2024). Impact of treatment and clinical characteristics on the survival of children with medulloblastoma in Mexico. Frontiers in oncology, 14, 1376574. https://doi.org/10.3389/fonc.2024.1376574

2. Ronsley, R., Cole, B., Ketterl, T., Wright, J., Ermoian, R., Hoffman, L. M., Margol, A. S., & Leary, S. E. S. (2024). Pediatric Central Nervous System Embryonal Tumors: Presentation, Diagnosis, Therapeutic Strategies, and Survivorship-A Review. Pediatric neurology, 161, 237–246. https://doi.org/10.1016/j.pediatrneurol.2024.09.031