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

Abstract

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.