Radiotherapy of central nervous system tumors in young children: benefits and pitfalls.

Abstract

The prognosis for young children suffering from brain tumors is, as many authors report, generally poor. The probability of late complications in young children is also high, and their quality of life is significantly worse than that of older children. This study presents the experience of one center in management of central nervous system tumors in children in aged 1-3 years with radiation therapy. From 1981 to 1990, 52 children (aged 1-3 years) with CNS tumors were treated at the First Radiotherapy Department in the Center of Oncology in Warsaw, Poland. These patients represented 18% of the total number of 293 children with brain and spine tumors treated in this period. The radiation treatment policy for young children was similar to that applied to older children, but total doses and doses per fraction were lower and did not exceed 50 Gy to the tumor site and 30 Gy to the CNS axis. Overall 5-year survival was 52%, and disease-free survival was 50%. These results were similar to those obtained in older children (53% and 50%, respectively). Serious mental retardation (IQ < 70) was observed in 30% of young children in comparison to 7% of older patients, but in 62% these symptoms were noted even before the start of radiotherapy. The results obtained in this series did not confirm the hypothesis of more aggressive biology of CNS tumors in younger children. The proportion of children with serious psychological disturbances in this group is apparently high, although in most cases these symptoms were observed before the start of radiotherapy and were a result of tumor mass effects.