Subsequent quality of life for children irradiated for a brain tumor before age four years

Abstract

Background We wanted to evaluate survival and functional morbidity following radiation treatment of brain tumors in children less than 4 years old. Procedure Outcome was evaluated for 222 children who were less than 4years old when they were irradiated at University of Toronto Centres, 1958–1995. The status of the survivors with regard to focal neurological defects, vision, hearing, and education at last follow-up was recorded. In 23 adult survivors older than 21 years at last follow-up, information was obtained with regard to higher education, occupation, and living arrangements. Results The overall 10-year survival rate was 40%, not significantly different than the 45% for 776 4–16-year-olds with irradiated brain tumors treated at the same institutions. Forty-five percent of the survivors had no major focal neurological, visual, or hearing defects. There were no major differences in the frequencies of these criteria or of schooling between 0–2- and 2–4-year-olds. Among adult survivors, older than 21 at last follow-up, 26% successfully completed higher education, 31% were in full-time employment, and 37% had never been employed. For medulloblastoma, the 5-year survival rate was 61% for 30 children less than 3 years old and treated from 1975–1995. This compared favorably with recent reports of survival following primary chemotherapy with delayed or omitted radiation treatment. Summary Radiation treatment of a young child with a brain tumor was associated with cure in 1 of every 3 patients. Unfortunately, quality of life for many survivors was not good. Only one of every 3 adult survivors was able to have a normal life-style. This shortfall was the result of focal neurological defects which were present from the time of first treatment, and of the long-term effects of radiation treatment. Conclusions The search for less toxic treatment remains appropriate, but is experimental and researchers must recognize that there may be a trade-off between morbidity and mortality. Med. Pediatr. Oncol. 31:506–511, 1998. © 1998 Wiley-Liss, Inc.