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Pediatric Craniopharyngioma Survival Outcomes at the U.S.-Mexico Border: Results from a Cross-Border Neuro-Oncology
Alexander Tenorio1, Michael G Brandel1, Gautam R Produturi2
1Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA; Division of Pediatric Neurosurgery, Rady Children's Hospital, San Diego, California, USA.
Insights
The Cross-Border Neuro-Oncology Program improved access to care for pediatric craniopharyngioma patients, but survival remained suboptimal for Mexican children. Enhancing endocrine care and addressing delayed presentation are crucial for improving outcomes.
Area of Science:
- Pediatric neuro-oncology
- Craniopharyngioma management
- Cross-border healthcare initiatives
Background:
- Pediatric craniopharyngioma necessitates complex, multidisciplinary care.
- The Cross-Border Neuro-Oncology Program was established to enhance survival for Mexican children with brain tumors.
- Facilitating access to high-complexity neuro-oncology care was a key objective.
Purpose of the Study:
- To assess clinical and surgical characteristics and survival rates of pediatric craniopharyngioma patients.
- To compare outcomes between U.S. and Mexican children treated through the Cross-Border Neuro-Oncology Program.
- To identify factors influencing survival in this cross-border cohort.
Main Methods:
- Retrospective analysis of pediatric craniopharyngioma cases at Rady Children's Hospital, San Diego (RCHSD) from 2010-2022.
- Comparison of patients receiving follow-up care at RCHSD (U.S. cohort) versus Hospital General, Tijuana (HGT, Mexico cohort).
- Evaluation of clinical data, surgical characteristics, symptom duration, endocrine care compliance, and overall survival.
Main Results:
- A total of 35 children were included: 30 in the RCHSD cohort and 5 in the HGT cohort.
- The HGT cohort experienced longer symptom duration (24 weeks vs. 4 weeks) and lower postdischarge endocrine care compliance (50% vs. 100%).
- Overall survival was significantly lower in the HGT cohort (3-year: 80% vs. 100%; 5-year: 53% vs. 100%), with lack of endocrine care linked to poorer survival.
Conclusions:
- Despite improved access via the Cross-Border Neuro-Oncology Program, survival for Mexican pediatric craniopharyngioma patients remains suboptimal.
- Delayed presentation and inadequate postoperative endocrine management are key challenges.
- Future efforts should focus on infrastructure enhancements, dedicated pediatric endocrinology support, and improved training for early complication detection and management.
Background:
Management of pediatric craniopharyngioma requires complex, multidisciplinary care. To improve survival for Mexican children with brain tumors at the U.S.-Mexico border, we established the Cross-Border Neuro-Oncology Program and facilitated access to high-complexity neuro-oncology care.
Methods:
We retrospectively assessed clinical and surgical characteristics and survival in U.S. and Mexican children with craniopharyngioma at Rady Children's Hospital, San Diego (RCHSD) between 2010 and 2022. Patients received follow-up care at RCHSD (RCHSD cohort) or Hospital General, Tijuana (HGT), Mexico (HGT cohort).
Results:
Thirty-five children with craniopharyngioma were included: 30 patients (median age 8.7 years; interquartile range [5.1, 13.7], 60% male) in the RCHSD cohort and 5 patients (median age 14 years; interquartile range [7.0, 14.0], 20% male) in the HGT cohort. Children in the HGT cohort had longer symptom duration at presentation compared to the RCHSD cohort (24 weeks vs. 4 weeks; P = 0.011). Postdischarge endocrine care and compliance with endocrine treatment were lower in children in the HGT cohort versus RCHSD cohort (75% vs. 100%, P = 0.12, and 50% vs. 100%, P = 0.012, respectively). Overall survival was significantly lower in the HGT cohort compared to the RCHSD cohort (3-year: 80% vs. 100%, P = 0.016; 5-year: 53% vs. 100%, P = 0.003). Lack of postdischarge endocrine care was associated with lower overall survival in the HGT cohort versus RCHSD cohort (0% vs. 100%; P < 0.001).
Conclusions:
Despite providing access to complex neurosurgical care through the Cross-Border Neuro-Oncology Program for Mexican children with craniopharyngioma, survival was suboptimal. Delayed presentation and postoperative endocrine management will be addressed through infrastructure enhancements, engaging a pediatric endocrinologist at HGT, and providing training in early detection and management of complications.
