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Long-term follow-up of young children with brain tumors after irradiation
1Royal Marsden Hospital, Sutton, Surrey, UK.
Insights
Children treated for brain tumors with radiotherapy often experience long-term disabilities. This study found 58% of survivors had disabling neurological deficits, endocrine dysfunction, or intellectual disabilities, highlighting the need for less toxic treatments.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-oncology
Background:
- Young children with brain tumors face significant risks of long-term side effects from radiotherapy.
- Late sequelae can include neurological deficits, endocrine dysfunction, and intellectual disabilities.
Purpose of the Study:
- To determine the frequency and severity of neurological deficits, endocrine dysfunction, and intellectual disabilities in young children treated with radiotherapy for brain tumors.
- To assess long-term outcomes in survivors of pediatric brain tumors.
Main Methods:
- Retrospective study of 156 children aged 3 years or younger treated between 1952 and 1986.
- Assessment of late radiation side effects in 57 survivors through clinical examination, blood tests, and interviews.
- Analysis included cranio-spinal radiotherapy, surgery, and chemotherapy data.
Main Results:
- Median follow-up was 13 years; actuarial survival at 5 and 10 years was 49% and 44%.
- 58% of survivors experienced disabling long-term morbidities (mild to severe).
- Supratentorial tumors correlated with more neurological deficits, parasellar tumors with more endocrine issues, and epilepsy with poor cognitive function.
Conclusions:
- Long-term morbidity is a significant issue for over half of surviving children treated for brain tumors.
- Findings emphasize the critical need for developing treatment strategies to minimize radiation toxicity.
- Further research into less toxic therapeutic approaches is warranted.
Purpose:
Young children with brain tumors are at high risk of developing late sequelae after curative radiotherapy. A retrospective study was undertaken to determine the frequency and severity of neurological deficits, endocrine dysfunction, and intellectual disabilities.
Methods And Material:
One hundred and fifty-six children age < or = 3 years were treated between 1952 and 1986 with radiotherapy. Of the 57 survivors, 47 had surgery, 12 chemotherapy and 24 children received cranio-spinal radiotherapy. Late radiation side effects were assessed with a clinical examination, blood tests and an interview.
Results:
The median follow-up was 13 years and the actuarial survival at 5 and 10 years was 49% and 44%, respectively. No, or only a mild, handicap was noted in 24 patients, while 21 had moderately severe and 16 severe disabilities. Children with supratentorial tumors had more abnormal neurological findings compared to those with infratentorial malignancies (p < 0.001). Eighty percent of children had endocrine abnormalities, which were more marked in children with parasellar tumors (p < 0.001). Twenty-one children were mentally retarded. In a multivariate analysis epilepsy emerged as the only significant variable independently associated with poor cognitive function.
Conclusion:
Long-term morbidity was found to be disabling in 58% of the surviving children. These findings encourage the development of treatment strategies designed to reduce toxicity.
