The significance of clinical, histopathological and radiotherapeutic parameters for the prognosis of brain tumors in children

Cilj: Ova studija je imala za cilj da evaluira karakteristike dece sa primarnim tumorima mozga, efikasnost modaliteta lečenja i da otkrije faktore povezane sa ishodom. Metode: Načinjena je detaljna analiza serije od 173 pedijatrijska pacijenta lečena u referentnoj ustanovi, Institutu za onkologiju i radiologiju Srbije, u periodu od 2007. do 2016. godine, na osnovu njihovih kliničkih, patohistoloških, terapijskih i podataka sa kontrolnih pregleda. Rezultati: Srednje vreme preživljavanja dece iznosilo je 94,5 meseci. Kumulativne verovatnoće preživljavanja od 2, 5 i 10 godina iznosile su 68,8%, 59,4% i 52,8%, respektivno. Pacijenti sa supratentorijalnim tumorima imali su duže preživljavanje od pacijenata sa infratentorijalnim i tumorima u oba kompartmenta. Deca sa nepoznatom patohistološkom formom i gliomima visokog gradusa imala su kraći život od dece sa embrionalnim tumorima, ependimomima i gliomima niskog gradusa. Preživljavanje dece koja su podvrgnuta totalnoj resekciji bilo je značajno duže od dece kod koje je postignut manji stepen resekcije. Pacijenti bez bolesti po prijemu u naš Institut živeli su duže od pacijenata sa lokalnom rezidualnom bolešću i pacijenata sa diseminovanom bolešću. Univarijantnom analizom, faktori koji su predviđali loš ishod bili su prezentacija bolesti sa hormonskim abnormalnostima, lokalizacija tumora, NFS i proširenost bolesti, dok su faktori koji su predviđali bolji ishod bili uzrast, prezentacija bolesti sa neurološkim deficitom i opseg resekcije. Multivarijantnom analizom, proširenost bolesti je ostala jedini jak faktor rizika za preživljavanje. Zaključak: Deca sa tumorima mozga imaju šansu za dugogodišnjim preživljavanjem. Uz rad obučenog i posvećenog multidisciplinarnog tima, mogu se postići adekvatni rezultati u lečenju ove dece.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 referral institution, Institute of Oncology and Radiology of Serbia, 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 and patients with tumors in both compartments. Children with the unknown histopathology and high-grade glioma had a shorter life than embryonal tumors, ependymoma, and low-grade glioma. Survival of children who underwent gross total resection was significantly longer than the children in whom lesser degrees of resection were achieved. Patients with no evidence of disease upon admission to our Institute lived longer than patients with local residual disease and patients with disseminated disease. By the univariate analysis, factors predicting poor outcome in our series were the presentation of disease with hormonal abnormalities, tumor location, NFS and the extent of the disease, while the factors predicting a better outcome were age, 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. Conclusions: Children with brain tumors have a chance for long-term survival. With a trained and dedicated multidisciplinary team, adequate outcomes can be achieved