Outcomes in adulthood after neurosurgical treatment of brain tumors in the first 3 years of life: long-term follow-up of a single consecutive institutional series of 97 patients

Abstract

Background Long-term outcome for children who underwent surgery for brain tumors in the first 3 years of life is not wellknown. Methods We performed a retrospective study on surgical morbidity, mortality rate, academic achievement, and work participation in children below 3 years of age who underwent primary tumor resection for a brain tumor in the period from 1973 to 1998. Gross motor function and activities of daily life were scored according to the Barthel Index. Long-term survivors were defined as with a survival from primary diagnosis of 20 years or more. Findings Ninety-seven consecutive children were included. No patient was lost to follow-up. Gross total resection was achieved in 67 children during the primary procedure, 25 had subtotal resections, and 5 had only partial resection. The 20-year survival figures for the 46 children with high-grade tumors was 33%, and the corresponding figures for 51 patients treated for low-grade tumors was 82%. Five of the 57 20-year-survivors died 21, 29, 30, 30, and 41 years, respectively, following primary surgery. Fifty of the 52 long-term survivors had a Barthel Index (BI) of 100, while the remaining two had a BI of 40. Twelve patients were long-term survivors after treatment for HG tumors (26%), while 40 of the 51 patients treated for LG tumors (78%) were alive. Thirty-two of the 52 long-term survivors were in full-time work and 29 of them after treatment for LG tumors. Another 10 were in part-time work, while the last 10 individuals had no working capacity. Conclusion Survival is better for patients with low-grade tumors compared with those with high-grade tumors. The functional level of long-term survivors is affected by adjuvant therapy and radiotherapy in particular. Neurosurgical intervention in itself is safe and plausible for pediatric brain tumor patients below 3 years of age. However, there should be a focus on potential late affects, and survivors should be followed by knowledgeable clinical staff for the neoplastic disease as well as for potential side effects. In this consecutive series, a 33% 20-year survival for children treated for HG tumors and 82% for patients with LG tumors was observed. The patients with LG tumors who had been treated with surgical resection without any adjuvant therapy showed a good clinical outcome as adults, and two-thirds of them were in full-time work.

Re: Lundar T, Due-Tønnessen BJ, Frič R, Brandal P, Stensvold E, Due-Tønnessen P. Outcomes in adulthood after neurosurgical treatment of brain tumors in the first 3 years of life: long-term follow-up of a single consecutive institutional series of 97 patients. Childs Nerv Syst. 2021 Feb;37 (2):427-433

“…Dear Editor, We compliment Lundar et al [1] on their important report of functional outcomes more than 20 years after treatment of neurosurgical treatment of brain tumors in the 1st 3 years of life. Pillai et al [2] reported a somewhat similar assessment of functional outcomes in children treated for brain tumors in the first year of life, followed for a minimum of 5 years after surgery.…”

“…We were surprised and disappointed that Lundar et al [1] omitted to cite this report, which is one of the most pertinent to their study. Indeed, on a PubMed search for "long-term outcomes after brain tumor in infants," this article by Pillai et al [2] came up as #6 when using the "best match" display option.…”

Outcomes in adulthood after neurosurgical treatment of brain tumors in the first 3 years of life: long-term follow-up of a single consecutive institutional series of 97 patients

“…We thank Steinbok and Pillai for their response to our paper "Outcomes in adulthood after neurosurgical treatment of brain tumors in the first 3 years of life: long-term follow-up of a single consecutive institutional series of 97 patients" [1]. They express compliments but also regret that their paper from 2012 was not listed in our references [2].…”

Brain tumors in the first two years of life

“…In a study investigating the remote outcome in survivors who reached adulthood [91], it was found that 33% of patients with high grade tumors became long-term survivors in contrast to 20-year survival rate of 82% in patients with low grade tumors. Regarding the clinical and functional outcome of high-grade lesions group of patients, it was reported that most of them were affected by severe late effects of radiotherapy given in their first year of life including second neoplasms, cerebrovascular disease, and coronary valvular disease, and three died at the age of 29, 30, and 41 years.…”