Is there a correlation between duration of presenting symptoms and stage of medulloblastoma at the time of diagnosis?

BACKGROUND

Does a "delay in diagnosis" lead to a child being diagnosed with advanced stage as opposed to early stage medulloblastoma? Correlation between the duration of a patient's presenting symptoms and stage at diagnosis was examined.

METHODS

The population consisted of 72 consecutive patients with histologically proven medulloblastoma diagnosed between July 1, 1983 and July 31, 1995. A standard history and physical examination format was used to record the nature and duration of presenting symptoms. Patients were staged by use of the operative findings, pre- and postoperative cranial computed tomography (CT) scans and, later in the series, cranial magnetic resonance imaging (MRI) studies and, for determination of the M stage, myelography, spinal MRI, and postoperative cerebrospinal fluid cytology.

RESULTS

There were 40 males (56%) and 32 females (44%) with a mean age of 11.8 years. The most common presenting symptoms were vomiting (67%), headache (60%), ataxia (40%), and nausea (39%). By the Chang-Harisiadis (CH) system, 39 patients (54%) were found to have high stage medulloblastoma (T3b-4M0 or any TM1-4), 27 (38%) had low stage disease (T1-3aM0), and in 6 (8%) the stage could not be fully determined. By the Langston modification of the Change-Harisiadis system (LCH) 38 patients (54%) had high stage, 24 (32%) had low stage, and in 10 (14%) the stage could not be fully determined. Fifty of the 66 patients for whom the duration of symptoms was known (76%) had < or = 3 months of symptoms prior to stage. High CH stage patients had a mean duration of symptoms of 7.4 +/- 6.9 weeks versus 19.5 +/- 22.5 weeks for low stage patients. (P < 0.001). High LCH stage patients had a mean duration of symptoms of 7 +/- 6.6 weeks versus 15.4 +/- 16.4 weeks for low stage patients (P < 0.01). Patients ultimately found to have MO disease were diagnosed more slowly (16.1 +/- 20 weeks) than those with M1 (7.3 +/- 5.3 weeks), M2 (6 +/- 5.3 weeks), or M3 disease (6.8 +/- 5.9 weeks) M0 vs. M1-3, P < 0.02). No patients had M4 disease. Using an alternative definition of high versus low stage (T4M0 or any TM1-4 vs. T1-3bM0) currently under consideration by pediatric oncologists, the duration of symptoms remained significantly longer for low stage disease in the CH system (high vs. low, 7.2 +/- 5.8 weeks vs. 17.5 +/- 19.1 weeks, P < 0.01) but not in the LH system (high vs. low, 10.6 +/- 16.1 weeks vs. 13.9 +/- 15.9 weeks, P not significant).

CONCLUSIONS

A short duration of symptoms is associated with the diagnosis of more advanced medulloblastoma. This finding has significant potential implications for the identification of prognostic groups in medulloblastoma as well as medical-legal claims of "delay in diagnosis" and capitated health care issues.