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Brain tumors in children under 2 years: treatment, survival and long-term prognosis
B H Cohen1, R J Packer, K R Siegel
1Department of Neurology, Cleveland Clinic Foundation, OH 44195-5223.
Insights
Pediatric brain tumor survival is poor for infants under two. Chemotherapy alone offers survival benefits, and surgery with chemotherapy may lead to better intellectual function in survivors compared to radiation.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Childhood Brain Tumors
Background:
- Infants diagnosed with brain tumors (<2 years) face dismal survival rates and poor quality of life.
- A significant cohort of young children with brain tumors were treated at Children's Hospital of Philadelphia between 1975-1987.
Purpose of the Study:
- To evaluate the survival and long-term outcomes for children under two years of age diagnosed with brain tumors.
- To compare the efficacy of different treatment modalities, including chemotherapy and radiation, on survival and neurological function.
Main Methods:
- Retrospective analysis of 78 pediatric patients under two years old diagnosed with brain tumors between 1975 and 1987.
- Tumor sites included posterior fossa (40%) and supratentorial (60%).
- Treatment outcomes were assessed based on tumor type (malignant vs. benign), treatment modality (chemotherapy, radiation, surgery), and patient survival, including relapse and neurological function.
Main Results:
- Overall survival was significantly better for benign tumors (73%) compared to malignant tumors (24%).
- Chemotherapy alone resulted in long-term survival for 10 patients, and delayed the need for radiation in 5 others.
- Survivors treated with surgery and chemotherapy demonstrated better intellectual function compared to those treated with radiation before age two.
Conclusions:
- Treatment with chemotherapy alone can lead to long-term survival in young children with brain tumors.
- Surgery combined with chemotherapy appears to be a superior treatment strategy for preserving intellectual function in pediatric brain tumor survivors under two years of age.
- Further research into optimal treatment strategies for this vulnerable population is warranted.
Abstract:
Survival for children with brain tumors less than 2 years of age at diagnosis is dismal, and the quality of life of long-term survivors poor. Between 1975 and 1987, 78 (13%) of 579 patients with brain tumors treated at Children's Hospital of Philadelphia were under 2 years of age. Tumor site was posterior fossa in 31 (40%) and supratentorial in 47 (60%). Nine of 37 patients (24%) with malignant tumors, and 30 of 41 (73%) patients with benign tumors are alive with a mean follow-up of 116 months. Long-term survival after treatment with chemotherapy alone occurred in 10 patients, including 3 with malignant tumors. In 5 additional patients, chemotherapy delayed the need for irradiation a mean of 30 months. Of the 29 patients who relapsed after initial therapy, 12 are alive without progressive disease (2 patients with malignant tumors and 10 with benign tumors) a mean of 80 months after relapse, 2 children are alive with progressive disease, and 14 died a median of 48 months (range 9-115 months) after relapse. Twenty-one of the 39 survivors have minimal or no neurological or intellectual dysfunction. Surviving patients treated with surgery and chemotherapy have better intellectual function than patients treated with surgery and radiation (with or without chemotherapy) in that 8 of 10 children treated with surgery and chemotherapy have normal or above normal intelligence compared with 5 of 12 children receiving irradiation before their second birthday.