Paediatric central nervous system tumours in a New Zealand population: A 10-year experience of epidemiology, management strategies and outcomes

Clinical profile, treatment and outcome of pediatric brain tumors in Serbia in a 10-year period: A national referral institution experience

Objective

This study aimed to evaluate the characteristics of children with primary brain tumors, the effectiveness of treatment modalities, and to detect factors related to the outcome.

Methods

A detailed analysis was performed on a series of 173 pediatric patients treated in a Serbian referral oncology institution between 2007 and 2016, based on their clinical, histological, treatment, and follow-up data.

Results

Mean survival time of all children was 94.5months. 2-, 5- and 10-year overall survival probabilities were 68.8%, 59.4%, and 52.8%, respectively. Patients with supratentorial tumors had longer survival than patients with infratentorial tumors and patients with tumors in both compartments (p = 0.011). Children with the unknown histopathology (brainstem glioma) and high-grade glioma had a shorter life than embryonal tumors, ependymoma, and low-grade glioma (p<0.001). Survival of the children who underwent gross total resection was longer than the children in whom lesser degrees of resection were achieved (p = 0.015). The extent of the disease is a very important parameter found to be associated with survival. Patients with no evidence of disease after surgery had a mean survival of 123 months, compared with 82 months in patients with local residual disease and 55 months in patients with disseminated disease (p<0.001). By the univariate analysis, factors predicting poor outcome in our series were the presentation of disease with hormonal abnormalities, tumor location, and the extent of the disease, while the factors predicting a better outcome were age at the time of diagnosis, presentation of the disease with neurological deficit, and type of resection. By the multivariate analysis, the extent of the disease remained as the only strong adverse risk factor for survival (HR 2.06; 95% CI = 1.38–3.07; p<0.001).

Conclusions

With an organized and dedicated multidisciplinary team, the adequate outcomes can be achieved in a middle-income country setting. The presence of local residual disease after surgery and disseminated disease has a strong negative effect on survival.

Epidemiology of paediatric central nervous system tumours in Queensland, Australia

Within Australia, there is little epidemiologic information regarding paediatric central nervous system (CNS) tumours. This study examined the epidemiology of childhood CNS tumours at Queensland Children's Hospital (QCH), the major paediatric referral centre for Queensland and northern New South Wales. We assessed the data from 221 newly diagnosed childhood CNS tumours across a five-year period from 2015 to 2019. Recurrent tumours were excluded. Data was collected on patient age, gender, histopathological diagnosis, tumour grade, anatomical site, and residential geographical location. The incidence within this period ranged from 2.65 to 3.85 cases per 100,000 children. The median symptom interval was 30 days (IQR 14-122) with presenting features similar to previous studies. The symptom interval was shorter for children zero to three years compared to children four years or older. The most frequent tumour was pilocytic astrocytoma, followed by medulloblastoma and Langerhans cell histiocytosis. The posterior fossa was the most frequent anatomical location for tumours. Our study demonstrated a shorter symptom interval in comparison to previous literature. The study was able to determine the incidence and presenting features within an Australian population.

Paediatric posterior fossa tumour resection rates in a small volume centre: the past decade's experience

BACKGROUND

Paediatric brain tumour resection rates have been shown to correlate with outcome and, it is argued, are linked to operator volume and caseload. The British paediatric neurosurgery community has previously debated centralisation of paediatric neuro-oncology. At the 2018 British Paediatric Neurosurgery Group (BPNG) meeting, a commitment was made to prospectively collect tumour resection data at each Neurosurgical Unit (NSU). Here we review our prospectively-collected 10-year database of the three commonest paediatric posterior fossa tumours - astrocytomas, medulloblastomas and ependymomas.

MATERIALS AND METHODS

Our primary outcome was extent of resection (EOR) on post-operative MRI scans reviewed by neuro-radiologists. Secondary outcomes comprised neurosurgical morbidity including infection, need for cerebrospinal fluid (CSF) diversion and the occurrence of posterior fossa syndrome (PFS).

RESULTS

55 children had 62 operations, where our complete resection rates for pilocytic astrocytomas, medulloblastomas and ependymomas were 77%, 79% and 63%, respectively. Both our primary and secondary outcomes were in keeping with the published literature and we discuss here some of the factors which may contribute towards favourable outcomes in a small volume centre.

CONCLUSION

Our results suggest that small volume centres can expect equivalent results to larger volume NSUs with regards to paediatric brain tumour surgery. Continuing efforts nationally for data collection on resection rates and operative outcomes is a key step towards optimising management in these children.

Estimation of radiation-induced second cancer risk associated with the institutional field matching craniospinal irradiation technique: A comparative treatment planning study

Aim

To estimate and compare the lifetime attributable risk (LAR) of radiation-induced second cancer (SC) in pediatric medulloblastoma patients planned with institutional 3D conformal field matching method, gap junction method and Intensity Modulated Radiotherapy (IMRT).

Background

The epidemiological studies on childhood cancer survivors reported that long-term cancer survivors who received radiotherapy are at a significantly increased risk for the development of SC. Hence, the increased concern to predict the SC risk for long-term survivors.

Materials and methods

In addition to institutional field matching planning method, IMRT and gap junction methods were created for ten pediatric medulloblastoma patients. The risk estimates were made based on the site-specific cancer risk coefficient provided by the BEIR VII committee according to the organ equivalent dose for various critical organs. Also, plans were compared for target volume dose distribution and dose received by critical organs.

Results

When compared to the gap junction method, the IMRT and institutional field matching method were superior in normal tissue sparing and dose conformity. However, highly significant volume of low dose associated with IMRT was the main concern for the SC risk. The accumulated LAR for all the critical organs with 3D conformal gap junction and IMRT method was 23-25% while for the 3D conformal field matching method it was 21%.

Conclusion

The LAR associated with the institutional field matching technique was substantially lower. As this method is highly robust and easy to set up, it can be a better choice of a craniospinal irradiation technique where 3DCRT is the only choice of treatment.

[Brain tumors in children: about 136 cases]

Les tumeurs cérébrales sont les tumeurs solides les plus diagnostiquées chez les enfants de moins de 15 ans dans le monde. Toutefois, peu de publications ont rapporté le profil épidémiologique et anatomopathologique de ces tumeurs en Afrique et particulièrement au Maroc. Les auteurs rapportent les particularités épidémiologiques et anatomopathologiques des tumeurs cérébrales primitives de l'enfant dans la région de Marrakech (Sud du Maroc). C'est une étude rétrospective réalisée au service d'anatomie pathologique du CHU Mohammed VI de Marrakech de 2004 à 2016. Cent trente-six cas de tumeurs cérébrales primitives étaient diagnostiqués avec une moyenne de 11,33 cas par an. L'âge moyen était de 8,28 ans. Le sex-ratio (H/F) était de 1,6 avec une légère prédominance masculine. Ces tumeurs étaient infra-tentorielles dans 61,53% des cas et siégeaient en supra-tentoriel dans 38,47% des cas. A l'étage infra-tentoriel, les tumeurs des hémisphères cérebelleux occupaient le premier rang (61,4%). Parmi les dix-huit types histologiques diagnostiqués, l'astrocytome et le médulloblastome représentaient ensemble 46,32% (29,41% et 16,91% respectivement). Dans notre contexte, la majorité des tumeurs cérébrales de l'enfant prédominait dans les 2 groupes d'âge: 5-9 ans et 10-15 ans. Les résultats épidémiologiques de ces tumeurs au sud du Maroc concordent majoritairement avec ceux déjà publiés du Nord du pays et des autres pays non Africains.

Clinical Characteristics and Prognostic Factors of Treatment in Pediatric Posterior Cranial Fossa Ependymoma

OBJECTIVE

The purpose of this study was to explore the clinical features and risk factors of outcomes in pediatric posterior cranial fossa ependymoma. We aim to provide evidence-based recommendations for the improvement of prognoses.

PATIENTS AND METHODS

The clinical data, treatment modalities, approaches performed, recurrence rates and times, as well as the outcomes of 94 cases were analyzed retrospectively. The characters of neuroimaging were further studied.

RESULTS

In data from the most recent follow-up, 27 cases had tumor recurrence. The time for tumor recurrence was 13.7 ± 7.7 months. The estimated overall survival and progression-free survival, based on Kaplan-Meier analysis, was 42.2 ± 2.9 months and 38.7 ± 3.4 months, respectively. Univariate analysis showed that being free of recurrence is closely related to the high tumor sphericity (p = 0.018), homogeneity of tumor texture (p = 0.001), and gross total resection (GTR; p < 0.001). Mortality is linked to low sphericity (p = 0.017) and brain stem edema (p = 0.005). Cerebellar mutism is correlated with posterosuperior compression of the 4th ventricle roof by the tumor. The incidence rate of cerebellar ataxia, cerebellar mutism, and cerebellar dysarthria is related to the rostral extension of the tumor within the 4th ventricle. The recurrence rate is higher in subtotal resection (STR) than in GTR, and the difference is significant (p < 0.001). Although there is no significant difference between the recurrence rates in the three types, an earlier recurrence is prone with tumors located in the paramidline-lateral compared to the midline (p = 0.021) and paramidline-medial areas (p = 0.042).

CONCLUSIONS

Based on our data, GTR is indicated as the most optimal choice. Recurrence is linked to lower tumor sphericity, inhomogeneous tumor texture, and STR/partial resection. Tumor located on the lateral side might be prone for an early recurrence.

Posterior cranial fossa tumours in children at National Cancer Institute, Sudan: a single institution experience

BACKGROUND

Posterior cranial fossa tumours (PCF) comprise 54-70% of childhood brain tumours. The clinical profile and outcomes of these tumours differ in area of the world. The aim of this study is to describe clinical characteristics, treatment and outcome of posterior cranial fossa tumours in Sudan.

MATERIAL AND METHODS

A retrospective study of children diagnosed with posterior cranial fossa tumours and treated between January 1998 and December 2015 at National Cancer Institute, Sudan.

RESULTS

A total of 31 paediatric patients with a posterior cranial fossa brain tumour were identified over the study period. The mean age was 7.9 years (standard deviation (SD) = 3.37). Females were slightly more affected (51%) than males (49%), and the majority of patients were from rural areas (71%). Brainstem tumours were the most frequent tumour type (48%) followed by medulloblastoma (36%). The mean pre-diagnostic symptomatic interval was 3.6 months (SD = 3.95). Overall survival rate of our total study population at 1, 2 and 5 years was 23, 19 and 13%, respectively.

CONCLUSION

Overall, this study draws attention to the situation of paediatric brain tumours in Sudan. Late presentation, misdiagnosis and limited diagnostic and treatment resources are challenges that may contribute to poor outcome in these patients.

Pediatric central nervous system tumors: review of a single Portuguese institution

INTRODUCTION

Despite being the second most frequent tumor in children, pediatric central nervous system (CNS) tumors are rare, and the published European epidemiological data is limited. Our goal is to present the first surgical series of pediatric CNS tumors in Portugal and to review other similar worldwide series.

METHODS

Retrospective review of all patients younger than 19 years old, operated to a CNS tumor in the Neurosurgery Department at Hospital de Santa Maria (Lisbon, Portugal) between January 2004 and December 2014. Demographic data, tumor location, clinical data, histopathology, and surgical treatment were analyzed and compared to surgical series of pediatric CNS tumors published in PubMed indexed journals over the last 20 years.

RESULTS

We performed 253 surgeries in 215 patients, with a male:female ratio of 1.2:1 and a mean age of 9.2 years old. Primary brain tumors accounted for 95 % of all tumors and had more often a supratentorial location. Tumors of neuroepithelial tissue, particularly astrocytic tumors, embryonal tumors, neuronal and mixed neuronal-glial tumors, and oligodendrogliomas accounted for 81 % of cases. A gross-total resection was achieved in most cases. There was no mortality, and the overall morbidity was low.

CONCLUSIONS

The demography, topography, and clinical presentation of the tumors and the surgical results of this series are comparable to other European ones. We found a higher incidence of neuronal and mixed neuronal-glial tumors and oligodendrogliomas and a slight lower incidence of ependymomas. Our results should encourage further national multi-institutional studies to better characterize these tumors in the pediatric population.

International variations in childhood cancer in indigenous populations: a systematic review

Although the cancer burden in indigenous children has been reported in some countries, up to now, no international comparison has been made. We therefore aimed to assess the available evidence of the burden of childhood cancer in indigenous populations. We did a systematic review of reports on cancer incidence, mortality, and survival in indigenous children worldwide. Our findings highlight the paucity of accessible information and advocate the pressing need for data by indigenous status in countries where population-based cancer registries are established. The true extent of disparities between the burden in the indigenous community needs to be measured so that targeted programmes for cancer control can be planned and implemented.

Paediatric brain tumours treated at a single, tertiary paediatric neurosurgical referral centre from 1999 to 2010 in Australia

Paediatric brain tumours are the most common solid tumour of childhood and the most common cancer cause of death among children. A retrospective review of 313 histopathologically proven brain tumours over an 11-year period has been performed at the Children's Hospital Westmead, New South Wales, Australia, to determine proportions and locations of different tumours, age distribution, survival rates and usage of various treatment modalities. Pilocytic astrocytoma was the most common paediatric brain tumour (29%) followed by medulloblastoma (12%) and ependymoma (6%). Most tumours were histologically benign (59%), and 42% of tumours were located in the posterior fossa. The average age at diagnosis was 7.9 years. About 50% of children were treated with surgery alone, whereas the other 50% had surgery or biopsy plus adjuvant treatment. The overall one-year survival rate was 89% and the five-year survival rate was 80%. The five-year survival rates for pilocytic astrocytoma was 91%; medulloblastoma, 75%; ependymoma, 82%; and high grade glioma, 15%. Thus, a large proportion of paediatric brain tumours were histologically benign and were treated with surgery alone, but a subset of benign tumours required adjuvant treatment and were associated with mortality (25%). The overall survival rates were high and are improving, although for some tumours, such as high grade glioma, the outlook remains poor.

Prognostic significance of angiogenesis in relation to Ki-67, p-53, p-27, and bcl-2 expression in embryonal tumors

AIM

We investigated the angiogenesis and density of newly formed blood vessels in embryonal tumors in relation to Ki-67, bcl-2, p-53 and p-27 expression.

METHODS

Forty-five children with embryonal tumors were enrolled in the study. Forty patients had a medulloblastoma (MB) and 5 patients had atypical teratoid/rhabdoid tumor (AT/RT).

RESULTS

In MB, the 5-year PFS and OS was 62.5 and 70%, respectively. Patients with Ki-67 index >50%, bcl-2 index >30% and higher density of new vessels were associated with worse survival. In the multivariate analysis, Ki-67 index was identified as a factor with independent prognostic power. In AT/RTs, high density of new vessels (>25 HRF) was observed in 3 patients and Ki-67 index over 25% was found in 4 patients.

CONCLUSION

Increased Ki-67, bcl-2 and density of new vessels are of prognostic value for the disease outcome in MB.

Incidence and management of high grade glioma in Māori and non-Māori patients

A retrospective analysis of 301 patients was undertaken between 1993 and 2003 to evaluate the relationship of ethnicity with incidence, treatment and survival in patients undergoing surgery for high grade glioma (HGG) in New Zealand. There was no difference in age standardised incidence of HGG in Māori compared to non-Māori patients; 4.2/100,000 person years (95% confidence interval [CI] 2.6-6.9) versus 4.1 (95% CI 3.6-4.6). Māori were more likely to have complete tumour resection (odds ratio 3.59 (95% CI 1.01-12.76)) but waited 1.32 (95% CI 0.98-1.79) times longer for radiotherapy. Median survival was 29 weeks with poorer survival in Māori compared to non-Māori (hazard ratio 1.55 [95% CI 0.95-2.55]). We concluded that the incidence of HGG in Māori is similar to non-Maori. However, Māori with HGG have higher rates of complete resection but wait longer for radiotherapy and may have poorer overall survival than non-Māori.

Cancer disparities in indigenous Polynesian populations: Māori, Native Hawaiians, and Pacific people

Polynesia consists of several islands that are scattered across a vast triangle in the Pacific, and include New Zealand, Hawaii, and the Pacific islands. There are reported differences in the types of cancer and epidemiologies seen among communities in these islands, the reasons for which are diverse and complex. In this Review, we describe patterns of cancer incidence, mortality, and survival in indigenous populations compared with populations of European origin in Polynesia, and highlight the limited available data for Pacific populations. Additionally, we document the current knowledge of the underlying biology of cancers in these populations, and report risk factors that differ between ethnicities, including smoking, viral infections, and obesity. Disparities in measures of health are highlighted, as are evident differences in knowledge of tumour biology and cancer management between majority and minority populations.

Spontaneous regression of low-grade gliomas in pediatric patients without neurofibromatosis

OBJECTIVE

Pediatric low-grade gliomas comprise a diverse range of central nervous system tumors, sharing the usual course of a slow progression in growth. In individual cases however, the natural history can be variable, and rarely spontaneous regression has been described. This paper describes factors associated with spontaneous regression.

METHODS

A literature review was performed to identify factors associated with spontaneous regression. A unique case is described to contribute to the findings.

RESULTS

Low-grade gliomas occurring in association with neurofibromatosis are more likely to spontaneously regress. Only 14 cases of spontaneous regression of low-grade gliomas in patients without neurofibromatosis have been described, and of these, the vast majority regress in association with optic chiasm gliomas. We describe the first documented case of spontaneous regression of a temporal lobe pilocytic astrocytoma in a patient without neurofibromatosis.

CONCLUSION

Spontaneous regression of low-grade gliomas can occur for tumors in a diversity of anatomical locations, at varying ages and in both sexes. This may have implications for management. As such, spontaneous tumor regression is an important outcome to be considered for pediatric low-grade gliomas and pilocytic astrocytomas.