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Younger brain tumor patients have significantly worse outcomes than older pediatric patients

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A researcher at the University of Colorado (CU) Cancer Center has found, through extensive data analysis, that the youngest brain tumor patients – those aged from birth to 3 months – have about half the five-year survival rate of children aged 1 to 19. .

In research results recently published in the Journal of Neuro-Oncology, Adam Green, MD, associate professor of pediatric hematology/oncology at the CU School of Medicine, and his co-researchers analyzed population-based data for nearly 14,500 children ages 0 to 19 who received a diagnosis of brain tumors. They found significantly worse results in younger patients.

“It’s unusual to see infants or babies with brain tumors, but we do see them,” says Green. “We generally don’t have the same standards of treatment as for older children. We also know that infants cannot report their own symptoms as older children often can.”

Analysis of national cancer data

Green and his co-researchers used data from the National Cancer Institute’s Surveillance, Epidemiology, and Endpoints (SEER) Program, a national cancer registry that covers more than a quarter of the U.S. population and represents the large diversity of the country.

The researchers extracted SEER data on childhood brain tumors and divided it into three age groups: 0 to 3 months, 3 to 6 months, and 6 to 12 months. They compared data from these three groups with data on brain tumors in people aged 1 to 19.

What they found, says Green, is that “the types of brain tumors that babies get are different from those in older patients, and that’s an important finding in itself. The most important findings that we We had were that the survival of babies from brain tumors is worse than in older children for almost all types of brain tumors that we study.”

Further analysis of the data showed that the five-year survival in the 0-3 month age group is between 30-35%, while the five-year survival in the 1-19 month age group years is about 70%. Five-year survival in the 3-6 month and 6-12 month age groups was also significantly lower than in older children.

Decreasing survival rates for younger brain tumor patients

This stark contrast in five-year survival rates “suggests that there may just be a lot of confusion, concern, and reluctance in the pediatric neuro-oncology community to give these infants treatment or perform a surgery,” says Green. “That may be a big reason why these kids aren’t doing as well. They’re also more likely to have metastatic disease when they have cancer, in part because they can’t report their own symptoms. , so their diagnosis may be delayed.”

Tumors in younger patients have a different biology than tumors in older children and are often diagnosed on prenatal ultrasounds. Symptoms are also different in different age groups. Older children may present with headaches or vomiting, while “babies obviously do not report headaches, but they may be inconsolably fussy for long periods of time or have a rapidly expanding head circumference that outgrows the curves growth,” says Green. “They may not reach developmental milestones or have abnormalities in the way their eyes move. Symptoms may be more subtle and not typical of the usual symptoms of brain tumors in older children.”

A particular challenge in treating younger brain tumor patients is that, although there are established standards of care and treatment for pediatric brain tumors, health care providers may be reluctant to use them on many occasions. very young babies.

“We have radiation savings plans that we use for children under 5, and we know they work well, but when it comes to patients that young, it can come from parents or parents. and medical teams thinking it’s going to be too toxic,” says Green. “There’s a concern that patients this young won’t tolerate the surgery.”

A goal of raising awareness

Green says he hopes an immediate effect of the study is to inform the health-care community of declining five-year survival rates for children under age 1 who develop brain tumors. In turn, he hopes this awareness will lead to an increased willingness to apply standard therapies to younger brain tumor patients.

“Longer term, we still need to better understand the biology of these tumors,” says Green. “We now understand how a certain type of brain tumor in an infant is different from that same type of brain tumor in an older child and we may need dedicated and specialized treatment protocols for these younger children.”

Additionally, since many brain tumors in younger patients are already metastatic at the time of diagnosis, “hopefully this will send the message out to the general pediatric community to be vigilant of this possibility,” said said Green. “These tumors are rare, but primary care pediatricians and others in primary care should be aware that these tumors can occur in infants. The biggest takeaway is that these patients are simply not getting the treatment that would be considered standard in older children.”