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Improving Outcomes in Paediatric Patients With Posterior Fossa Tumours: The Rapid Assessment Pathway in
Quratulain Tariq1, Irfana Ishaq Sindhu2, Saad Bin Anis3
1Department of Neurosurgery, Shaukat Khanum Cancer Hospital and Research Center, Lahore, Pakistan.
Insights
The Rapid Assessment Pathway (RAPT) significantly reduced treatment delays for pediatric posterior fossa tumors. This expedited care improved patient outcomes by shortening the time to surgery and adjuvant therapy.
Area of Science:
- Pediatric neuro-oncology
- Surgical oncology
- Clinical pathway optimization
Background:
- Posterior fossa tumors pose significant challenges due to location and diagnostic delays.
- Early detection of pediatric brain tumors is crucial for improved survival rates.
- Advances in diagnostics and surgical techniques have doubled survival for these tumors over two decades.
Purpose of the Study:
- To evaluate the effectiveness of a Rapid Assessment Pathway (RAPT) compared to a Regular Pathway for pediatric posterior fossa tumors.
- To determine if RAPT reduces diagnostic and treatment delays.
- To assess the impact of RAPT on surgical timing and adjuvant therapy initiation.
Main Methods:
- Retrospective comparative cohort study of 59 pediatric patients with posterior fossa tumors.
- Comparison between Regular Pathway and Rapid Assessment Pathway (RAPT) cohorts.
- Analysis of symptom duration, time to treatment acceptance, surgical intervention, and adjuvant therapy initiation.
Main Results:
- RAPT reduced the mean time to acceptance for treatment from 15 days to 5 days (p ≤ 0.001).
- Significantly fewer shunt insertions were required in the RAPT cohort.
- 83% of RAPT patients received surgery within 72 hours, versus 55% within 4 weeks in the Regular Pathway (p ≤ 0.001).
- Adjuvant therapy initiation was faster in RAPT (within 6 weeks) compared to the Regular Pathway (7 weeks).
Conclusions:
- The Rapid Assessment Pathway (RAPT) significantly improves the timeliness of care for pediatric posterior fossa tumors.
- RAPT facilitates early intervention, leading to better patient outcomes.
- RAPT effectively reduces treatment delays in managing pediatric posterior fossa tumors.
Introduction:
Posterior fossa tumours present substantial clinical challenges due to their deep anatomical location and proximity to vital neurovascular structures. Limited awareness and diagnostic delays remain major obstacles to early detection of paediatric brain tumours. For the last two decades, the 5-year overall and event-free survival of children with posterior fossa tumours has been doubled due to the improvement in the diagnostic tools and the advances in the surgical techniques approaching total or near-total resection.
Materials And Methods:
This retrospective comparative cohort study was conducted at a tertiary care cancer hospital in Pakistan, following approval from the Institutional Review Board (IRB). The study included paediatric patients with posterior fossa tumours treated between January 2021 and February 2025 and compared two cohorts: the Regular Pathway and the Rapid Assessment Pathway (RAPT). Collected variables included demographic characteristics, duration of symptoms, time interval from initial symptom onset to acceptance for treatment (from walk-in clinic), surgical intervention, frequency of shunt or external ventricular drain insertion and initiation of adjuvant therapy. Data were analysed using SPSS version 27.
Results:
A total of 59 patients were included, 30 patients in the Regular Pathway (January 2021-December 2023) and 29 patients in RAPT (January 2024-February 25). In the Regular Pathway, the mean duration of acceptance after initial presentation was 15 days, as compared to RAPT, which was 5 days (p ≤ 0.001). The frequency of shunt insertion was reduced significantly in RAPT compared to Regular Pathways. A total of 83% of patients in RAPT were operated within 72 h of acceptance as compared to Regular Pathway cohorts, in which 55% patients had surgery within 4 weeks (p ≤ 0.001). The average duration of the start of adjuvant therapy in the RAPT cohort was within 6 weeks, while in the Regular Pathway cohort, it was 7 weeks.
Conclusion:
RapidRAPT has demonstrated a significant improvement in the timeliness of care for paediatric patients diagnosed with posterior fossa tumours. Early intervention facilitated by RAPT contributes to better outcomes and reduced treatment delays.
