Tumeurs cérébrales de l’enfant : morbidité et suivi à l’âge adulte

Toward a transitional care from childhood and adolescence to adulthood in surgical neurooncology? A lesson from the Necker-Enfants Malades and the Sainte-Anne Hospitals collaboration

OBJECTIVE

Transitional care in surgical neurooncology is poorly studied. However, this period is pivotal, since it allows the patient to be empowered in his or her disease management. Here, the authors describe the experience of the Necker-Enfants Malades and the Sainte-Anne Hospital collaboration.

METHODS

The mixed transitional consultations started in September 2019 in a dedicated space for transitional care, named the "La Suite" department, located in the Necker-Enfants Malades Hospital, Paris, France. The authors organized planned consultations to schedule the clinical and radiological follow-up in the adult neurosurgical department but also emergency consultations to manage tumor recurrence in young adult patients. Transitional care was performed jointly by pediatric and adult neurosurgeons who have developed clinical and research skills in the field of surgical neurooncology. Neuropathological analysis was performed by a neuropathologist who is specialized in pediatric and adult neurooncology.

RESULTS

Fourteen patients benefited from a mixed transitional consultation. All of them accepted to start their management in an adult neurosurgical environment. Eleven patients (78.6%) for whom the disease was controlled benefited from a planned consultation. Three patients (21.4%) required rapid neurosurgical management for a tumor recurrence (n = 2) or for a new primary CNS tumor (n = 1) and benefited from an emergency consultation.

CONCLUSIONS

For adult patients harboring a brain tumor during childhood or adolescence, the authors suggest that neurosurgeons specialized in adult surgical neurooncology with a full knowledge in pediatric neurooncology will combine the required skills to optimize care management for these patients within a dedicated multidisciplinary organization framework.

Increased cerebrospinal fluid cleaved tau protein (C-tau) levels suggest axonal damage in pediatric patients with brain tumors

OBJECTIVE

This study aims to determine if cerebrospinal fluid/serum cleaved tau protein and CSF 9-hydroxyoctadecadienoic acid levels, reflecting potential biomarkers of overall neuronal injury and lipid peroxidation, respectively, are elevated in brain tumor patients compared with controls.

DESIGN

This article is a prospective clinical observational study.

SETTING

This study is conducted at a tertiary-care children's hospital.

PATIENTS

Our participants are children younger than or equal to 18 years of age undergoing brain tumor surgery.

MEASUREMENTS AND MAIN RESULTS

During the study period, 26 consecutive patients newly diagnosed with brain tumors who met the inclusion criteria were prospectively enrolled. Baseline cerebrospinal fluid analysis of cleaved tau and 9-hydroxyoctadecadienoic acid were measured in 15 patients. Cerebrospinal fluid cleaved tau and 9-hydroxyoctadecadienoic acid levels were measured in 22 patients for post-surgery days 1 and 3. Serum cleaved tau levels were measured for 20 and 18 patients for post-surgery days 1 and 3, respectively. The presence of a brain tumor significantly increased the baseline cerebrospinal fluid cleaved tau levels but did not affect cerebrospinal fluid 9-hydroxyoctadecadienoic acid levels. Similarly, there was a significant increase in post-surgery day 1 cerebrospinal fluid cleaved tau levels from baseline (p = 0.01) and a trend toward significant decrease in post-surgery day 3 cerebrospinal fluid cleaved tau from day 1 (p = 0.07). 9-Hydroxyoctadecadienoic acid concentrations remained relatively constant over time with no differences noted between the control and brain tumor patients. There was a trend towards a significant association between cerebrospinal fluid cleaved tau levels and duration of symptoms (p = 0.07).

CONCLUSIONS

Cerebrospinal fluid cleaved tau levels in children with newly diagnosed brain tumors exhibit markedly elevated cerebrospinal fluid cleaved tau levels, suggesting axonal damage. This axonal injury does not seem to correlate with lipid peroxidation at least when as assessed by cerebrospinal fluid 9-hydroxyoctadecadienoic acid levels. There was no association found between the biomarkers and multiple independent variables obtained at pre- and post-tumor resection.

Morbidity and tumor-related mortality among adult survivors of pediatric brain tumors: a review

INTRODUCTION

The health status of adult survivors of pediatric brain tumors is poorly documented. Documenting their health risks regarding tumor recurrence or new tumor, endocrine, and cognitive sequels, as well as their social outcome, would help to define their medical needs when they become adults. Identifying risk factors of late morbidity could help to improve treatment protocols in order to reduce the burden of sequels.

PURPOSE

We decided to review retrospectively our pediatric oncology database, in order to study the oncological and clinical outcome of adult patients treated for brain tumor during childhood.

MATERIALS AND METHODS

We selected patients treated under the age of 18, and followed clinically after the age of 20.

RESULTS

We studied 207 patients, aged 20.2-45 years at last control. Forty eight (23%) presented with late progression of the initial tumor, and 29 (14%) developed new tumors requiring surgery; 7 died of tumor progression. The main sequels were endocrine in 88 patients (44%), and cognitive in 86 (43%); only 36 patients (18%) had no sequel at all. The Karnofsky score was ≥ 80 (independent) in 73%; however, only 48% of evaluable patients were normally employed. Among the variables related to initial treatment, reoperation was the most significant factor influencing negatively outcome; however, young age at irradiation was the only significant factor predicting poor employment status.

CONCLUSIONS

Adult patients treated for brain tumor in childhood are at significant risk of tumor progression, and many patients require prolonged oncological follow-up. Complex disabilities require the organization of efficient child-to-adult transition for these vulnerable patients.