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Intracranial Tumors in the First Year of Life
José Francisco M Salomão1, Tatiana Protzenko2
1Fernandes Figueira Institute - Oswaldo Cruz Foundation (IFF-Fiocruz), Rio de Janeiro, RJ, Brazil.
Insights
Intracranial tumors in infants are rare but aggressive pediatric cancers. Surgical removal extent is key for survival, despite advances in molecular diagnostics.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Neonatal Medicine
Background:
- Intracranial tumors are the second most common pediatric cancer in the first year of life, after leukemias.
- These tumors present unique challenges including high malignancy rates, large size, and vascularity, leading to higher morbidity and mortality.
- Diagnosis can be delayed due to subtle symptoms, despite advances in prenatal ultrasonography.
Purpose of the Study:
- To review the unique characteristics of intracranial tumors in neonates and infants.
- To discuss the common tumor types, diagnostic challenges, and treatment considerations.
- To highlight the prognostic factors and survival rates for this rare pediatric population.
Main Methods:
- Literature review of pediatric intracranial tumors in the first year of life.
- Analysis of epidemiological data, histological classifications, and clinical behaviors.
- Evaluation of the impact of diagnostic and therapeutic advances on patient outcomes.
Main Results:
- Pediatric low-grade gliomas, medulloblastoma, ependymoma, embryonal neoplasms (formerly PNETs), and teratomas are common in this age group.
- Tumor removal extent is the most critical prognostic factor, overriding molecular and genomic advances.
- Five-year survival rates vary widely, from 25% to 75%.
Conclusions:
- Intracranial tumors in infants possess distinct features compared to older children, necessitating specialized management.
- Despite diagnostic and therapeutic progress, surgical resection extent remains paramount for improving survival.
- Further research is needed to refine treatment strategies and improve outcomes for these rare and aggressive pediatric cancers.
Abstract:
Intracranial tumors in the first year of life are rare and, in this age group, are the second most common type of pediatric cancer after leukemias. As the more common solid tumor in neonates and infants, they present some peculiarities such as the high incidence of malignancies. Routine ultrasonography made easier to detect intrauterine tumors, but diagnosis can be delayed due to the lack or scarcity of recognizable symptoms. These neoplasms are often very large and highly vascular. Their removal is challenging, and there is a higher rate of morbidity and mortality than seen in older children, adolescents, and adults. They also differ from older children with respect to location, histological features, clinical behavior, and management. Pediatric low-grade gliomas represent 30% of the tumors in this age group and comprise circumscribed and diffuse tumors. They are followed by medulloblastoma and ependymoma. Other non-medulloblastoma embryonal neoplasms, former known as PNETS, are also commonly diagnosed in neonates and infants. Teratomas have an expressive incidence in newborns but decline gradually until the end of the first year of life. Immunohistochemical, molecular, and genomic advances are impacting the understanding and targeting of the treatment of some tumors, but, despite all these advances, the extent of resection remains the most important factor in the prognosis and survival of almost all types of tumors. The outcome is difficult to estimate, and 5-year survival ranges from one-quarter to three-quarters of the patients.
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