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Typical Pediatric Brain Tumors Occurring in Adults-Differences in Management and Outcome
Ladina Greuter1, Raphael Guzman1,2,3, Jehuda Soleman1,2,3
1Department of Neurosurgery, University Hospital of Basel, 4031 Basel, Switzerland.
Insights
Pediatric brain tumors like medulloblastoma, pilocytic astrocytoma, and craniopharyngioma present differently in adults versus children. Outcomes and treatments vary significantly by age, requiring specialized interdisciplinary care for both populations.
Area of Science:
- Neuro-oncology
- Pediatric Oncology
- Comparative Medicine
Background:
- Adult and pediatric brain tumors exhibit distinct characteristics.
- Certain pediatric brain tumors, including medulloblastoma, pilocytic astrocytoma, and craniopharyngioma, also occur in adults.
- Understanding these differences is crucial for effective treatment and improved outcomes.
Purpose of the Study:
- To delineate the differences in classification, treatment strategies, and patient outcomes for medulloblastoma, pilocytic astrocytoma, and craniopharyngioma in adult and pediatric populations.
- To highlight age-specific variations in tumor behavior and response to therapy.
Main Methods:
- Comparative review of medulloblastoma, pilocytic astrocytoma, and craniopharyngioma in adult and pediatric patients.
- Analysis of molecular subgroups, age-specific distribution, and survival rates.
- Evaluation of treatment approaches, including surgical resection and the importance of preserving specific structures.
Main Results:
- Medulloblastoma: WHO IV tumor with four molecular subgroups; survival rates differ significantly (adults: 25-83%, children: 50-90%).
- Pilocytic Astrocytoma: WHO I tumor; location differs by age (adults: supratentorial, children: cerebellum); survival ~85% (adults) vs >90% (children).
- Craniopharyngioma: Sellar region tumor; treatment prioritizes gross total resection in adults and hypothalamic preservation in children; survival ~90%.
Conclusions:
- Significant differences exist in the classification, treatment, and outcomes of common pediatric brain tumors when comparing adult and pediatric patients.
- Treatment protocols often originate from pediatric trials and require adaptation for adult neuro-oncology care.
- An interdisciplinary approach is essential for managing these complex brain tumors in both age groups.
Abstract:
Adult brain tumors mostly distinguish themselves from their pediatric counterparts. However, some typical pediatric brain tumors also occur in adults. The aim of this review is to describe the differences between classification, treatment, and outcome of medulloblastoma, pilocytic astrocytoma, and craniopharyngioma in adults and children. Medulloblastoma is a WHO IV posterior fossa tumor, divided into four different molecular subgroups, namely sonic hedgehog (SHH), wingless (WNT), Group 3, and Group 4. They show a different age-specific distribution, creating specific outcome patterns, with a 5-year overall survival of 25-83% in adults and 50-90% in children. Pilocytic astrocytoma, a WHO I tumor, mostly found in the supratentorial brain in adults, occurs in the cerebellum in children. Complete resection improves prognosis, and 5-year overall survival is around 85% in adults and >90% in children. Craniopharyngioma typically occurs in the sellar compartment leading to endocrine or visual field deficits by invasion of the surrounding structures. Treatment aims for a gross total resection in adults, while in children, preservation of the hypothalamus is of paramount importance to ensure endocrine development during puberty. Five-year overall survival is approximately 90%. Most treatment regimens for these tumors stem from pediatric trials and are translated to adults. Treatment is warranted in an interdisciplinary setting specialized in pediatric and adult brain tumors.
