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Subsequent quality of life for children irradiated for a brain tumor before age four years
D Jenkin1, C Danjoux, M Greenberg
1Toronto-Sunnybrook Regional Cancer Centre, Ontario, Canada.
Insights
Radiation therapy for pediatric brain tumors in children under 4 offers a 40% survival rate, but many survivors experience significant long-term functional deficits impacting quality of life.
Area of Science:
- Pediatric Oncology
- Radiation Oncology
- Neuro-oncology
Background:
- Evaluating survival and functional outcomes in young children (under 4 years) treated with radiation for brain tumors.
- Assessing the long-term impact of radiation therapy on survivors' quality of life.
Purpose of the Study:
- To assess survival rates and functional morbidity in children under 4 years old treated for brain tumors with radiation.
- To evaluate the long-term neurological, sensory, educational, and social outcomes of these survivors.
Main Methods:
- Retrospective analysis of 222 children under 4 years old treated with radiation for brain tumors (1958-1995).
- Evaluation of survivors for focal neurological defects, vision, hearing, and educational status.
- Assessment of higher education, occupation, and living arrangements in adult survivors (>21 years).
Main Results:
- Overall 10-year survival was 40%, comparable to older children (45% for 4-16 year olds).
- 45% of survivors had no major focal neurological, visual, or hearing defects.
- Among adult survivors, 26% completed higher education, 31% were employed, but 37% were never employed.
Conclusions:
- Radiation treatment achieved cure in one-third of young children with brain tumors, but quality of life was often compromised.
- Focal neurological deficits and long-term radiation effects contributed to poor quality of life in many survivors.
- While less toxic treatments are needed, the trade-off between morbidity and mortality must be considered.
Background:
We wanted to evaluate survival and functional morbidity following radiation treatment of brain tumors in children less than 4 years old.
Procedure:
Outcome was evaluated for 222 children who were less than 4 years old when they were irradiated at University of Toronto Centres, 1958-1995. The status of the survivors with regard to focal neurological defects, vision, hearing, and education at last follow-up was recorded. In 23 adult survivors older than 21 years at last follow-up, information was obtained with regard to higher education, occupation, and living arrangements.
Results:
The overall 10-year survival rate was 40%, not significantly different than the 45% for 776 4-16-year-olds with irradiated brain tumors treated at the same institutions. Forty-five percent of the survivors had no major focal neurological, visual, or hearing defects. There were no major differences in the frequencies of these criteria or of schooling between 0-2- and 2-4-year-olds. Among adult survivors, older than 21 at last follow-up, 26% successfully completed higher education, 31% were in full-time employment, and 37% had never been employed. For medulloblastoma, the 5-year survival rate was 61% for 30 children less than 3 years old and treated from 1975-1995. This compared favorably with recent reports of survival following primary chemotherapy with delayed or omitted radiation treatment.
Summary:
Radiation treatment of a young child with a brain tumor was associated with cure in 1 of every 3 patients. Unfortunately, quality of life for many survivors was not good. Only one of every 3 adult survivors was able to have a normal life-style. This shortfall was the result of focal neurological defects which were present from the time of first treatment, and of the long-term effects of radiation treatment.
Conclusions:
The search for less toxic treatment remains appropriate, but is experimental and researchers must recognize that there may be a trade-off between morbidity and mortality.