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Radiotherapy of central nervous system tumors in young children: benefits and pitfalls
1Department of Radiotherapy, Centre of Oncology-Maria Sklodowska-Curie Memorial Institute, Warsaw, Poland. gardas@cmkp.edu.pl
Insights
Pediatric brain tumor survival rates for 1-3 year olds treated with radiation therapy were comparable to older children. However, significant psychological disturbances were noted, often predating treatment in these young central nervous system tumor patients.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-oncology
Background:
- Young children with brain tumors face poor prognoses and high rates of late complications.
- Quality of life is significantly diminished in young pediatric cancer patients compared to older children.
- Central nervous system (CNS) tumors in 1-3 year olds present unique management challenges.
Purpose of the Study:
- To evaluate the outcomes of radiation therapy for central nervous system (CNS) tumors in children aged 1-3 years.
- To compare treatment results and long-term effects in very young children with CNS tumors to those in older pediatric patients.
- To investigate the incidence and timing of psychological disturbances in young children undergoing radiation therapy for brain tumors.
Main Methods:
- A cohort of 52 children aged 1-3 years with CNS tumors treated between 1981-1990 was analyzed.
- Radiation treatment protocols were adapted for young children, using lower total doses and fractional doses (≤50 Gy to tumor, ≤30 Gy to CNS axis).
- Outcomes including 5-year survival, disease-free survival, and rates of serious mental retardation (IQ < 70) were assessed.
Main Results:
- Overall 5-year survival was 52% and disease-free survival was 50%, similar to older children (53% and 50%).
- Serious mental retardation (IQ < 70) affected 30% of young children, compared to 7% in older patients.
- Crucially, 62% of these psychological disturbances were present before radiotherapy, attributed to tumor mass effects.
Conclusions:
- The study did not support the hypothesis of more aggressive tumor biology in younger children with CNS tumors.
- The high proportion of psychological disturbances in this young cohort appears linked to tumor burden rather than radiation effects.
- Management strategies for pediatric brain tumors in very young children should consider pre-existing neurological deficits.
Background:
The prognosis for young children suffering from brain tumors is, as many authors report, generally poor. The probability of late complications in young children is also high, and their quality of life is significantly worse than that of older children. This study presents the experience of one center in management of central nervous system tumors in children in aged 1-3 years with radiation therapy.
Procedure:
From 1981 to 1990, 52 children (aged 1-3 years) with CNS tumors were treated at the First Radiotherapy Department in the Center of Oncology in Warsaw, Poland. These patients represented 18% of the total number of 293 children with brain and spine tumors treated in this period. The radiation treatment policy for young children was similar to that applied to older children, but total doses and doses per fraction were lower and did not exceed 50 Gy to the tumor site and 30 Gy to the CNS axis.
Results:
Overall 5-year survival was 52%, and disease-free survival was 50%. These results were similar to those obtained in older children (53% and 50%, respectively). Serious mental retardation (IQ < 70) was observed in 30% of young children in comparison to 7% of older patients, but in 62% these symptoms were noted even before the start of radiotherapy.
Conclusions:
The results obtained in this series did not confirm the hypothesis of more aggressive biology of CNS tumors in younger children. The proportion of children with serious psychological disturbances in this group is apparently high, although in most cases these symptoms were observed before the start of radiotherapy and were a result of tumor mass effects.
