QOL-15QUALITY OF LIFE IN MASSIVE OPTICOHYPOTHALAMIC GLIOMA. AN ANALYSIS OF AN EXPERIENCE IN 73 CASES TREATED OVER 18 YEARS

Abstract

BACKGROUND: Visual pathway gliomas represent 1% to 5% of childhood brain tumors. About 43% occur in children <10 years old. Although benign, opticohypothalamic chiasmatic gliomas can have aggressive course in young children. PATIENTS AND METHODS: Seventy-three cases of opticohypothalamic chiasmatic were surgically treated in our department over the past 18 years (1990-2011). A retrospective analysis is presented. A semi-structured interview for disease domain specific quality of life (QOL) was performed in a focused group of 30 patients to elicit themes to provide a thematic analysis. RESULTS: The average age of presentation was 14.8 years and duration of complaints was 3 months. Headaches, vomiting and dimunition of vision were the most common complaints. The average size of the tumor was 7.4 cm. All patients underwent only biopsy of the tumor. The subfrontal approach was used in all patients. Ventriculoperitoneal shunt was required in 19 patients postoperatively. The average follow-up period was 7 years. Nonsymptomatic recurrence was noted in 8 patients. Overall, the median time to tumor progression was 55 months. The 5- and 10-year survival probabilities were 93 and 74%, respectively. The functional activity assessed by Barthel's Index is maintained in children with low grade optochiasmal gliomas treated with conformal RT. The decline in functional activity is seen in patients with tumor recurrence and in complications. However, there was improvement of functional activity after RT due to tumour control and rehabilitative support. The maximum improvement was seen in visually impaired patients. CONCLUSION: Barthel's Index is a simple, reproducible, quick and easy to perform. It is especially applicable for older children and adolescents and may be used as an outcome measure tool in clinics with resource limitations. The approach towards quality of life issues should be more aggressive including psychosocial intergration. There is a need for more objective and better quality of life studies.