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Giant Supratentorial Brain Tumors in Children: Functional Outcome and Progression-Free Survival Analysis
Amparo Saenz1, Yamila Basilotta1, Emma A Dalton2
1Pediatric Neurosurgery Department, Pediatric Hospital Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
Insights
Pediatric giant supratentorial brain tumors (GSBTs) impact progression-free survival (PFS). High-grade tumors, multiple surgeries, poor functional status, and CNS infections negatively affect PFS in pediatric GSBT patients.
Area of Science:
- Pediatric neuro-oncology
- Neurosurgery
- Oncology
Background:
- Giant supratentorial brain tumors (GSBTs) present unique challenges in pediatric neurosurgery.
- Understanding factors influencing outcomes is crucial for optimizing treatment strategies.
Purpose of the Study:
- To identify factors affecting progression-free survival (PFS) in pediatric patients with GSBTs.
- To analyze the impact of these factors on long-term functional outcomes.
Main Methods:
- Retrospective, single-center cohort study of pediatric GSBT patients (January 2014 - June 2018).
- Minimum 24-month follow-up for PFS and overall survival (OS) analysis.
- Functional Status Score (FSS) assessed functional outcome.
Main Results:
- 27 pediatric patients with GSBTs included; 11 had grade IV tumors.
- 24-month PFS and OS rates were 51.85% and 74.04%, respectively.
- Worse PFS associated with postoperative FSS >16, >3 surgeries, high-grade tumors, and CNS infections.
Conclusions:
- Pediatric GSBTs require multidisciplinary management, considering surgical impact and quality of life.
- High-grade histopathology, multiple surgeries, poor postoperative functional status, and CNS infections are key factors influencing PFS.
Introduction:
This study aimed to identify factors affecting progression-free survival (PFS) in pediatric patients with giant supratentorial brain tumors (GSBTs) treated with surgical excision. The secondary aim was to analyze how these same factors affected the functional outcome in the long term.
Methods:
We performed a retrospective, analytical, single-center cohort study. We included all pediatric patients with GSBT between January 2014 and June 2018. Patients were followed for a minimum of 24 months for the PFS and overall survival (OS) analysis. Functional status score (FSS) was used to assess the functional outcome.
Results:
We included 27 patients with GSBT, the median age was six (range 2-12), and eleven patients had a grade IV tumor. The 24-month PFS and OS were 51.85% and 74.04%, respectively. A PFS-ending event or treatment failure occurred in 13 patients. We found that patients with postoperative FFS >16 have a worse PFS than patients with a postoperative FSS <15 (HR 4.51; p = 0.03). Patients with more than three surgeries had worse PFS than patients with one or two procedures (HR 11.39; p = 0.004). High-grade tumors were associated with worse PFS than low-grade tumors (HR 1.55; p = 0.04). Finally, patients with CNS infections had worse PFS than patients without that complication (HR 2.70; p = 0.04).
Conclusions:
GSBTs in pediatric patients are complex lesions that require multidisciplinary management. Surgical management and quality of life should be considered when choosing the best treatment. Factors influencing long-term PFS were high-grade histopathology, the need for three or more surgeries, postoperative FSS >16, and CNS infections.
