LMIC-23. PEDIATRIC CRANIOPHARYNGIOMA SURVIVAL OUTCOMES IN THE US-MEXICO BORDER: RESULTS FROM A CROSS-BORDER NEURO-ONCOLOGY PROGRAM

Abstract

Abstract BACKGROUND Management of pediatric craniopharyngioma requires complex, multidisciplinary care. Data on outcomes in low- and middle-income countries (LMIC) are lacking. To improve survival for children with brain tumors in the US-Mexico border, we established the Cross-Border Neuro-Oncology Program (CBNP) and facilitated access to high-complexity neuro-oncology for Mexican children. METHODS We retrospectively assessed clinical and surgical characteristics and progression-free survival (PFS) and overall survival (OS) in US and Mexican children who received neurosurgical intervention for craniopharyngiomas at Rady Children’s Hospital, San Diego (RCHSD) between January 2010 and December 2022. Patients either received follow-up care at RCHSD (RCHSD cohort) or returned to Hospital General, Tijuana (HGT), Mexico (HGT cohort) to continue care. RESULTS Thirty-five children with craniopharyngioma were included; 30 patients (mean age 8.7 years, 60% male) in the RCHSD cohort and five (mean age 14 years, 20% male) in the HGT cohort. The HGT cohort had longer symptom duration at presentation compared to the RCHSD cohort (24 weeks vs. 4 weeks, p=0.011). Pituitary dysfunction at diagnosis was observed in 20 (57%) patients, with growth hormone deficiency (n=17, 47%) being most common. Gross total resection was achieved in 32 (94%) patients. Seven (23%) patients in the RCHSD cohort received adjuvant therapies, compared to none in the HGT cohort (p = 0.6). Endocrine treatment compliance was lower in the HGT cohort vs..RCHSD cohort (50% vs. 100%, p=0.012). OS was significantly lower in the HGT cohort compared to the RCHSD cohort (67.3 months vs. N/A __ months, p< 0.001), whereas PFS was not different between cohorts. CONCLUSION Despite providing access to complex neurosurgical care through the CBNP for Mexican children with craniopharyngioma, we demonstrated lower survival. To address this inequity, delayed presentation and post-operative endocrine management will be addressed through infrastructure enhancements, engaging a pediatric endocrinologist at HGT, and providing training in early-detection and management of complications.