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Has modern management improved the outcome of infants with intracranial tumors?
R Kumar1, R A Jones, I H Tekkök
1Neurosurgical Unit, Royal Manchester Children's Hospital, Pendlebury, UK.
Insights
Pediatric intracranial tumors are rare, with 85% being malignant. While modern treatments improved 5-year survival rates for children, long-term outcomes and quality of life remain challenging.
Area of Science:
- Pediatric oncology
- Neuro-oncology
Background:
- Intracranial tumors in children under 18 months are rare, affecting 1 in 25,000 live births.
- Historically, 85% of these pediatric brain tumors were malignant, posing significant mortality risks.
Purpose of the Study:
- To analyze the incidence, management, and outcomes of intracranial tumors in infants and young children.
- To evaluate the impact of diagnostic and therapeutic advancements on survival rates and quality of life.
Main Methods:
- Retrospective review of 92 children diagnosed with intracranial tumors between 1953 and 1987.
- Analysis of diagnostic methods (including computed tomography introduction in 1976), surgical approaches, radiotherapy, and chemotherapy.
Main Results:
- A 1-month operative mortality rate of 15% was observed, despite aggressive surgical and early treatment strategies.
- Introduction of computed tomography (CT) improved diagnostic accuracy and enabled earlier detection.
- While 5-year survival rates significantly improved with modern management, overall survival and quality of life showed no substantial long-term gains. Axial tumors were universally fatal within 9 years.
Conclusions:
- Modern management, including CT, refined radiotherapy, and chemotherapy, has improved short-term survival for pediatric intracranial tumors.
- Significant challenges persist in improving long-term survival and quality of life for affected children.
- Further advancements are needed to address the high mortality associated with these rare pediatric malignancies.
Abstract:
Records of 92 children were reviewed who, in the first 18 months of life had an intracranial tumour, and who were registered with the Manchester Children's Tumour Registry during the 34-year period from 1953 to 1987. The incidence of intracranial tumour was 1 in 25,000 live births, and 85% of the tumours were malignant. The introduction of computed tomography (CT) in the region in 1976 improved the diagnostic accuracy and led to early diagnosis. This also coincided with refined radiotherapy and improved chemotherapy. The surgical attitude became more aggressive, and with early treatment, mortality was reduced, though the 1-month operative mortality still remains high at 15%. All survivors were available for follow-up. All children with axial tumours died within 9 years. Long-term follow-up did not suggest significant improvement in the overall survival or in the quality of life, though there was a significant improvement in the 5-year survival rate with modern management.