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Intracranial tumors in infants: long-term functional outcome, survival, and its predictors
Shibu Pillai1, Mary Metrie, Christopher Dunham
1Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and British Columbia Children's Hospital, Vancouver, BC, Canada V6H 3V4.
Insights
Survival and functional outcomes for infants with brain tumors are evaluated. Tumor grade is the key predictor of survival and good outcomes, with about a third achieving good results.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Outcomes Research
Background:
- Intracranial tumors in infants are rare but serious conditions.
- Long-term survival and functional outcomes for this population require further investigation.
Purpose of the Study:
- To evaluate survival rates and functional outcomes in infants diagnosed with primary intracranial tumors at least 5 years post-diagnosis.
- To identify predictors of survival and functional outcomes in this cohort.
Main Methods:
- Retrospective chart review of infants with primary intracranial tumors.
- Re-evaluation of radiology and pathology, with outcomes assessed using Bloom's categories and late effects severity scoring.
- Analysis of age, tumor location, size, resection extent, adjuvant therapy, and WHO grade as potential predictors.
Main Results:
- 20 out of 35 infants (57%) survived, with 12 (34%) achieving a good functional outcome.
- Survivors experienced various deficits, including neurological (70%), visual (45%), endocrine (25%), and auditory (15%).
- Older age and infratentorial location predicted poor outcome at presentation; however, WHO tumor grade was the sole independent predictor of survival and functional outcome post-diagnosis.
Conclusions:
- Approximately one-third of infants with brain tumors achieved good functional outcomes, with 28% able to attend regular school or secure skilled employment.
- Histological grade of the tumor, determined after tissue diagnosis, is the critical independent predictor of patient outcomes.
Objective:
Intracranial tumors are rare in the first year of life. This study evaluates survival rates and functional outcomes of survivors at least 5 years after diagnosis and the predictors of this outcome.
Methods:
A retrospective chart review of all infants with a primary intracranial tumor was carried out. Radiology and pathology were re-reviewed. Outcome was assessed at 5 years or more after diagnosis using Bloom's categories (Bloom 1-2 = good outcome, the rest = poor outcome) and late effects severity scoring. Age, tumor location, size, extent of tumor resection, type of adjuvant therapy given, and WHO grade of tumor histology were evaluated as predictors of outcome.
Results:
Among 35 infants, 20 (57%) survived, with 12 (34%) having a good outcome. Deficits among the survivors included neurological dysfunction in 14 (70%), visual impairment in 9 (45%), endocrine dysfunction in 5 (25%), and auditory disability in 3 (15%). Ten of the 20 survivors were either attending regular school or were engaged in a skilled job. At presentation, older age and an infratentorial location of the tumor are predictors of poor outcome. After histopathological diagnosis, the WHO grading of tumor is the only independent predictor of survival (p = 0.002) and functional outcome (p < 0.001).
Conclusion:
About a third of the infants diagnosed with brain tumors (34%) had a good functional outcome and approximately a quarter of them (28%) were able to attend regular school or take up a skilled job. After tissue diagnosis, histological grade of tumor is the only independent predictor associated with outcome.
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