Profile and outcome of pediatric brain tumors – Experience from a tertiary care pediatric oncology unit in South India

Abstract

Context:Tumors of the central nervous system (CNS) constitute the second most common pediatric cancers. Unlike leukemia, management of CNS tumors requires a good multidisciplinary team. Higher rates of treatment abandonment are documented in view of complexity of the treatment with long duration, involving neurosurgery, radiation, chemotherapy, and high cost of treatment. Morbidity associated with CNS tumors may be significant in terms of physical deficits as well as neuropsychological and neuroendocrine sequelae. Pediatric neurooncology is still at a very nascent stage in the developing countries. There are only a few reports on the multidisciplinary approach and outcomes of pediatric brain tumors in developing countries.Aims:The aim of this study is to identify the clinicopathological profile of Pediatric CNS tumors in a tertiary care center located in South India in comparison with reports from other low-and middle-income Countries.Settings and Design:A retrospective analysis of medical records of all children diagnosed with brain tumors from January 2012 to November 2016 at our institute was done.Subjects and Methods:A retrospective study of clinical, pathological profile, and outcomes of children <18 years diagnosed with brain tumors at our institute from January 2012 to November 2016 was done. Histopathological categorization was done as per the WHO classification 2007. The multidisciplinary treatment with respect to surgery, radiation, and chemotherapy was noted and the outcomes were recorded.Statistical Analysis Used:R for Statistical Computing (Version 3.0.2; 2013-09-25).Results:A total of 52 children were diagnosed with male preponderance of 66.6%. Highest incidence was noted in the age group of 0–4 years (50%). Majority of them were supratentorial (59.6%). CNS embryonal tumors contributed to 48% of all our brain tumors. 73% of them underwent either resection or biopsy. Eight (15.3%) of them died due to the progression of disease, but 44% abandoned treatment due to the progression/recurrence of disease. Those lost to follow-up were mostly among the high-risk groups with poor prognosis such as pontine glioma, medulloblastoma (high risk), and primitive neuroectodermal tumor.Conclusions:Although brain tumors constituted 30% of all our solid tumors, only 56% of them received appropriate treatment and 25% abandoned treatment. High rates of abandonment were a consequence of late diagnosis, complex multidisciplinary treatment involved, high treatment cost, lack of uniformity in management between different oncology centers and poor prognosis of the tumor subtype.

Características clínicas y epidemiológicas de niños con tumores del sistema nervioso central en Medellín, Colombia

“…On the other hand, an Iranian study with 198 children found that 63.1% (125) corresponded to the male gender, a result that is consistent with that reported by Azad et al 15 . As for clinical manifestations, headache and hemiparesis were the most frequently reported symptoms by Azad et al 14 , with 27% and 24.3% respectively, which are figures comparable with the data observed by our team, where the main symptoms were headache and nausea and/or vomiting with 41.2% and 29.4%, respectively, in contrast with the study conducted by Suresh et al 16 in southern India, where the main symptom was vomiting, with 62.5%, followed by headache in 37.5%. In concordance with Suresh et al 16 findings, in the study by Faranoush et al 15 , vomiting (n = 106, 53.5%) and headache (n = 102, 51.5%) were the main clinical findings.…”

“…As for clinical manifestations, headache and hemiparesis were the most frequently reported symptoms by Azad et al 14 , with 27% and 24.3% respectively, which are figures comparable with the data observed by our team, where the main symptoms were headache and nausea and/or vomiting with 41.2% and 29.4%, respectively, in contrast with the study conducted by Suresh et al 16 in southern India, where the main symptom was vomiting, with 62.5%, followed by headache in 37.5%. In concordance with Suresh et al 16 findings, in the study by Faranoush et al 15 , vomiting (n = 106, 53.5%) and headache (n = 102, 51.5%) were the main clinical findings. The indications for performing a neuroimaging examination are based on the index of suspicion with regard to the signs and symptoms observed in a patient; therefore, in every child with persistent headache (continuous or recurrent, for more than 4 weeks), a CNS tumor should be suspected, and neuroimaging examination is required to rule it out 17,18 .…”

“…The research team found that the most widely used treatment was surgery, performed in 87.1%, which is a similar figure to that reported by Azad et al 14 , 80%, out of which 52.5% required additional surgeries, while in our population only 14.1% were re-operated. Similarly, in the study carried out by Suresh et al 16 , surgery was described in 69% of cases. Regarding other types of treatment, Suresh et al 16 reported radiotherapy and chemotherapy in 53.8% and 50% respectively, which are dissimilar data to those herein reported, where chemotherapy and radiotherapy were reported in 47.1% and 21.2%, respectively.…”

The magnitude and predictors of therapy abandonment in pediatric central nervous system tumors in low‐ and middle‐income countries: Systematic review and meta‐analysis

“…No studies attempted to formally analyze predictors of treatment abandonment in CNS tumors. However, authors of 12 studies reported possible causes of abandonment (Table ), based on their personal experience with patients, patient records, and knowledge of patients’ backgrounds . Only one (Chinese) study conducted a questionnaire with caregivers to identify reasons for abandonment .…”

Medulloblastoma has a global impact on health related quality of life: Findings from an international cohort

“…Diagnostic and treatment protocols vary across the world due to—among other things—financial and logistic factors . Ultimately, these inconsistencies can result in a disparity of survival rates and HRQL . As such, it would be interesting to see if our results would differ if low to middle income countries were included.…”