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Brain metastasis in children with sarcoma, neuroblastoma, and Wilms' tumor
Arnold C Paulino1, Thanh X Nguyen, Jerry L Barker
1Department of Radiation Oncology, Emory University, Atlanta, Georgia, USA. arnold@radonc.emory.org
Insights
Brain metastasis is rare in pediatric sarcoma, neuroblastoma, and Wilms' tumor patients, often occurring with other distant disease. Radiotherapy improved outcomes for children with brain metastasis, enhancing freedom from neurologic progression.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Cancer Metastasis
Background:
- Brain metastasis is a significant concern in pediatric cancers.
- Understanding the incidence and prognosis of brain metastasis is crucial for treatment planning.
Purpose of the Study:
- To determine the incidence of brain metastasis in children diagnosed with sarcoma, neuroblastoma, or Wilms' tumor.
- To evaluate the prognosis and survival rates for pediatric patients with brain metastasis.
Main Methods:
- Retrospective review of medical and tumor registry records for 611 children treated between 1965 and 2000.
- Analysis included patients with sarcoma, neuroblastoma, or Wilms' tumor.
Main Results:
- Brain metastasis was identified in 4.9% of pediatric patients.
- Neuroblastoma had the highest incidence (8%), followed by rhabdomyosarcoma (6.7%).
- Median survival after brain metastasis diagnosis was 4 months, with a 1-year survival rate of 11.5%.
Conclusions:
- Brain metastasis is uncommon in this pediatric cohort and frequently associated with concurrent distant disease.
- Radiotherapy demonstrated a positive influence on freedom from neurologic progression in children treated for brain metastasis.
Purpose:
To determine the incidence and prognosis of children who develop brain metastasis.
Materials And Methods:
The medical and tumor registry records of 611 children treated at the University of Iowa Hospitals and Clinics between 1965 and 2000 for a sarcoma, neuroblastoma, or Wilms' tumor were reviewed.
Results:
Thirty children (4.9%) were found to have brain metastasis. Brain metastasis occurred in 9 of 113 (8%) neuroblastoma, 7 of 104 (6.7%) rhabdomyosarcoma, 6 of 105 (5.7%) Ewing's sarcoma, 5 of 106 (4.7%) osteosarcoma, 2 of 83 (2.4%) nonrhabdomyosarcoma soft-tissue sarcoma, and 1 of 100 (1%) Wilms' tumor patients. There were 22 male and 8 female patients, with a median age of 14 years at the time of diagnosis of brain metastasis (range 8 months-20 years). Four patients were diagnosed at autopsy, whereas five had brain metastasis at initial diagnosis. For the 25 children who did not have brain metastasis at initial presentation, the median interval from initial diagnosis to development of brain metastasis was 5 months (range 1-43 months). Twenty-nine (97%) had concurrent or prior history of distant metastasis. Eighteen (60%) had solitary brain metastasis. Treatment for the 26 non-autopsy-diagnosed children included surgery (S), followed by postoperative radiotherapy (RT) and chemotherapy (CT) in 2, S and postoperative RT in 1, RT and CT in 16, S alone in 2, CT alone in 2, RT alone in 1, and no treatment in 2. Median survival was 4 months after diagnosis of brain metastasis, with a 1-year survival rate of 11.5%. On multivariate analysis, only the use of RT was found to positively influence freedom from neurologic progression (p = 0.005).
Conclusion:
Brain metastasis is uncommon in children with a diagnosis of sarcoma, neuroblastoma, or Wilms' tumor and is often accompanied by concurrent distant disease. Children treated with RT for brain metastasis had a better freedom from neurologic progression rate than those who did not receive radiotherapy.