Clinicopathological Analysis of Pediatric Posterior Fossa Tumors: Insights from a National Neurosurgical Center
Iroda Mammadinova 1 * ,
Saparbek Seitbekov 1,
Dmitriy Surdin 1,
Sayagul Abdykarimova 1,
Abay Iskanov 1,
Aizat Isaeva 1,
Syrdankyz Ibatova 1,
Gabit Olenbay 1,
Serik Akshulakov 1 More Detail
1 Department of Pediatric Neurosurgery, National Centre for Neurosurgery, Astana, Kazakhstan
* Corresponding Author
J CLIN MED KAZ, Volume 21, Issue 2, pp. 73-79.
https://doi.org/10.23950/jcmk/14400
OPEN ACCESS
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Author Contributions: Conceptualization, I.M.; methodology, G.O.; validation, G.O.; formal analysis, I.M.; investigation, S.S. and D.S.; resources, A.B.I. and A.S.I.; data curation, S.A.; writing – original draft preparation, I.M.; writing – review and editing, I.M. and G.O.; visualization, I.M.; supervision, S.I. and S.A.; project administration, G.O. and S.I; funding acquisition, S.A. All authors have read and agreed to the published version of the manuscript.
Statement of Ethics: The Institutional Review Board of the National Center for Neurosurgery reviewed and exempted the study due to the retrospective study design. All participants in this study provided written informed consent prior to accessing their CT, MRI scans or identifying personal characteristics in this study.
ABSTRACT
BACKGROUNDː Pediatric posterior fossa tumors are the significant cause of morbidity and mortality in children and adolescents. This study aimed to investigate the characteristics of the patient population and report the experience in managing and treating children with these tumors, as well as their survival outcomes in Kazakhstan.
METHODSː This retrospective study analysed data from the archives of the Pediatric Neurosurgery Department and included 214 pediatric patients with PFT in the period from January 2015 to December 2020.
RESULTSː The study included 214 patients with a mean age of 7.29 ± 4.26 years. The most common tumor pathology observed in this study was medulloblastoma (33.18%). Grade I tumors showed a notable median survival of 56.64 months (95% CI, 53.93-59.35), surpassing Grade II tumors at 50.38 months (95% CI, 40.57-60.2). Grade III and IV tumors had median survivals of 38.64 months (95% CI, 31.11-46.17) and 38.76 months (95% CI, 33.96-43.56). Multivariate analysis using Cox regression model revealed significant predictors of overall survival. Grade III-IV tumors (RR = 0.577, 95% CI 0.462-0.720, p = 0.000), delayed resection (RR = 0.950, 95% CI 0.717-1.104, p = 0.000), and brainstem tumors (RR = 2.454, 95% CI 1.791-5.751, p = 0.000) had poorer survival. Tumor volume, age, and adjuvant chemotherapy were not significant predictors of 5-year survival (p > 0.05).
CONCLUSIONSː The study found similar death rates in children with pilocytic astrocytoma compared to other population studies. Regrettably, the 5-year survival rate for medulloblastoma and ependymoma indicates a poorer outcome compared to previous reports.
CITATION
Mammadinova I, Seitbekov S, Surdin D, Abdykarimova S, Iskanov A, Isaeva A, et al. Clinicopathological Analysis of Pediatric Posterior Fossa Tumors: Insights from a National Neurosurgical Center. J CLIN MED KAZ. 2024;21(2):73-9.
https://doi.org/10.23950/jcmk/14400
REFERENCES
- Ostrom QT, de Blank PM, Kruchko C, et al. Alex's Lemonade Stand Foundation Infant and Childhood Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2007-2011. Neuro Oncol. 2015; 16 Suppl 10(Suppl 10):x1-x36. https://doi.org/10.1093/neuonc/nou327
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2022. CA Cancer J Clin. 2022; 72(1):7-33. https://doi.org/10.3322/caac.21708
- Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer Statistics, 2021. CA Cancer J Clin. 2021; 71(1):7-33. https://doi.org/10.3322/caac.21654
- D'Arco F, Khan F, Mankad K, Ganau M, Caro-Dominguez P, Bisdas S. Differential diagnosis of posterior fossa tumours in children: new insights. Pediatr Radiol. 2018; 48(13):1955-1963. https://doi.org/10.1007/s00247-018-4224-7
- Cheshier S, Taylor MD, Ayrault O, Mueller S. Introduction. Pediatric brain tumor. Neurosurg Focus. 2020; 48(1):E1. https://doi.org/10.3171/2019.10.FOCUS19799
- Nabors LB, Portnow J, Ahluwalia M, et al. Central Nervous System Cancers, Version 3.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020; 18(11):1537-1570. Published 2020 Nov 2. https://doi.org/10.6004/jnccn.2020.0052
- Udaka YT, Packer RJ. Pediatric Brain Tumors. Neurol Clin. 2018; 36(3):533-556. https://doi.org/10.1016/j.ncl.2018.04.009
- Quon JL, Bala W, Chen LC, et al. Deep Learning for Pediatric Posterior Fossa Tumor Detection and Classification: A Multi-Institutional Study. AJNR Am J Neuroradiol. 2020; 41(9):1718-1725. https://doi.org/10.3174/ajnr.A6704
- Terashima K, Ogiwara H. No Shinkei Geka. 2021; 49(3):640-646. https://doi.org/10.11477/mf.1436204438
- Shih RY, Koeller KK. Embryonal Tumors of the Central Nervous System: From the Radiologic Pathology Archives. Radiographics. 2018; 38(2):525-541. https://doi.org/10.1148/rg.2018170182
- Grønbæk JK, Wibroe M, Toescu S, et al. Postoperative speech impairment and surgical approach to posterior fossa tumours in children: a prospective European multicentre cohort study. Lancet Child Adolesc Health. 2021;5(11):814-824. https://doi.org/10.1016/S2352-4642(21)00274-1
- Rodriguez Gutierrez D, Awwad A, Meijer L, et al. Metrics and textural features of MRI diffusion to improve classification of pediatric posterior fossa tumors. AJNR Am J Neuroradiol. 2014; 35(5):1009-1015. https://doi.org/10.3174/ajnr.A3784
- Phuttharak W, Wannasarnmetha M, Wara-Asawapati S, Yuthawong S. Diffusion MRI in Evaluation of Pediatric Posterior Fossa Tumors. Asian Pac J Cancer Prev. 2021;22(4):1129-1136. Published 2021 Apr 1. https://doi.org/10.31557/APJCP.2021.22.4.1129
- Zhou H, Hu R, Tang O, et al. Automatic Machine Learning to Differentiate Pediatric Posterior Fossa Tumors on Routine MR Imaging. AJNR Am J Neuroradiol. 2020;41(7):1279-1285. https://doi.org/10.3174/ajnr.A6621
- Nikam RM, Yue X, Kaur G, et al. Advanced Neuroimaging Approaches to Pediatric Brain Tumors. Cancers (Basel). 2022;14(14):3401. Published 2022 Jul 13. https://doi.org/10.3390/cancers14143401
- Stensvold E, Krossnes BK, Lundar T, et al. Outcome for children treated for medulloblastoma and supratentorial primitive neuroectodermal tumor (CNS-PNET) - a retrospective analysis spanning 40 years of treatment. Acta Oncol. 2017;56(5):698-705. https://doi.org/10.1080/0284186X.2017.1301679
- Louis DN, Perry A, Wesseling P, et al. The 2021 WHO Classification of Tumors of the Central Nervous System: a summary. Neuro Oncol. 2021;23(8):1231-1251. https://doi.org/10.1093/neuonc/noab106
- Lester A, McDonald KL. Intracranial ependymomas: molecular insights and translation to treatment. Brain Pathol. 2020; 30(1):3-12. https://doi.org/10.1111/bpa.12781
- Rudà R, Reifenberger G, Frappaz D, et al. EANO guidelines for the diagnosis and treatment of ependymal tumors. Neuro Oncol. 2018; 20(4):445-456. https://doi.org/10.1093/neuonc/nox166
- Kishwar Jafri SK, Bakhshi SK, Shamim MS. Management of paediatric intracranial ependymoma. J Pak Med Assoc. 2021;71(4):1288-1289.
- Millard NE, De Braganca KC. Medulloblastoma. J Child Neurol. 2016;31(12):1341-1353. https://doi.org/10.1177/0883073815600866
- Stocco C, Pilotto C, Passone E, et al. Presentation and symptom interval in children with central nervous system tumors. A single-center experience. Childs Nerv Syst. 2017; 33(12):2109-2116. https://doi.org/10.1007/s00381-017-3572-1
- Alves CAPF, Löbel U, Martin-Saavedra JS, et al. A Diagnostic Algorithm for Posterior Fossa Tumors in Children: A Validation Study. AJNR Am J Neuroradiol. 2021; 42(5):961-968. https://doi.org/10.3174/ajnr.A7057
- E.K.Duysembekov. Incidence of malignant brain tumors in children in Kazakhstan. Journal Neurosurgery and Neurology of Kazakhstan. 2019; 2-3: 27-28.
- U.K. Zhumashev, S.N. Kaldarbekov, B. Ualikhanuly. Major malignant tumors in children in the republic of Kazakhstan. Vestnik KazNMU. 2022(1); 180-186.
- Stiller CA, Bayne AM, Chakrabarty A, Kenny T, Chumas P. Incidence of childhood CNS tumours in Britain and variation in rates by definition of malignant behaviour: population-based study. BMC Cancer. 2019;19(1):139. Published 2019 Feb 11. https://doi.org/10.1186/s12885-019-5344-7
- Beier D, Kocakaya S, Hau P, Beier CP. The Neuroradiological Spectra of Adult and Pediatric Medulloblastoma Differ : Results from a Literature-based Meta-analysis. Clin Neuroradiol. 2018; 28(1):99-107. https://doi.org/10.1007/s00062-016-0517-0
- Neumann JE, Spohn M, Obrecht D, et al. Molecular characterization of histopathological ependymoma variants. Acta Neuropathol. 2020;139(2):305-318. https://doi.org/10.1007/s00401-019-02090-0
- Fangusaro J, Bandopadhayay P. Advances in the classification and treatment of pediatric brain tumors. Curr Opin Pediatr. 2021;33(1):26-32. https://doi.org/10.1097/MOP.0000000000000975
- Picariello S, Spennato P, Roth J, et al. Posterior Fossa Tumours in the First Year of Life: A Two-Centre Retrospective Study. Diagnostics (Basel). 2022;12(3):635. Published 2022 Mar 4. https://doi.org/10.3390/diagnostics12030635
- Chu JK, Chiarelli PA, Rea ND, et al. Postoperative facial palsy after pediatric posterior fossa tumor resection. J Neurosurg Pediatr. 2021; 27(5):566-571. https://doi.org/10.3171/2020.9.PEDS20372
- Qin Q, Huang D, Jiang Y. Survival difference between brainstem and cerebellum medulloblastoma: the surveillance, epidemiology, and end results-based study. Medicine (Baltimore). 2020; 99(41):e22366. https://doi.org/10.1097/MD.0000000000022366
- Parsons MW, Whipple NS, Poppe MM, Mendez JS, Cannon DM, Burt LM. The use and efficacy of chemotherapy and radiotherapy in children and adults with pilocytic astrocytoma. J Neurooncol. 2021; 151(2):93-101. https://doi.org/10.1007/s11060-020-03653-y
- Aras Y, Dölen D, İribas Çelik A, et al. Effects of different molecular subtypes and tumor biology on the prognosis of medulloblastoma. Childs Nerv Syst. 2021;37(12):3733-3742. https://doi.org/10.1007/s00381-021-05350-1
- Toescu SM, Aquilina K. Current and Emerging Methods of Management of Ependymoma. Curr Oncol Rep. 2019; 21(9):78. Published 2019 Jul 29. https://doi.org/10.1007/s11912-019-0826-y
- Rasalkar DD, Chu WC, Paunipagar BK, Cheng FW, Li CK. Paediatric intra-axial posterior fossa tumours: pictorial review. Postgrad Med J. 2013; 89(1047):39-46. https://doi.org/10.1136/postgradmedj-2011-130075
- Li Q, Dai Z, Cao Y, Wang L. Comparing children and adults with medulloblastoma: a SEER based analysis. Oncotarget. 2018; 9(53):30189-30198. Published 2018 Jul 10. https://doi.org/10.18632/oncotarget.23773
- Lopez-Rivera V, Dono A, Abdelkhaleq R, et al. Treatment trends and overall survival in patients with grade II/III ependymoma: The role of tumor grade and location. Clin Neurol Neurosurg. 2020;199:106282. https://doi.org/10.1016/j.clineuro.2020.106282
- Klawinski D, Indelicato DJ, Hossain J, Sandler E. Surveillance imaging in pediatric ependymoma. Pediatr Blood Cancer. 2020; 67(11):e28622. https://doi.org/10.1002/pbc.28622
- Ait Khelifa-Gallois N, Laroussinie F, Puget S, Sainte-Rose C, Dellatolas G. Long-term functional outcome of patients with cerebellar pilocytic astrocytoma surgically treated in childhood. Brain Inj. 2015;29(3):366-373. https://doi.org/10.3109/02699052.2014.975281
- Alford R, Gargan L, Bowers DC, Klesse LJ, Weprin B, Koral K. Postoperative surveillance of pediatric cerebellar pilocytic astrocytoma. J Neurooncol. 2016; 130(1):149-154. https://doi.org/10.1007/s11060-016-2222-x
- Hammad M, Hosny M, Khalil EM, Alfaar AS, Fawzy M. Pediatric ependymoma: A single-center experience from a developing country. Indian J Cancer. 2021; 58(3):378-386. https://doi.org/10.4103/ijc.IJC_373_19
- Baliga S, Gandola L, Timmermann B, et al. Brain tumors: Medulloblastoma, ATRT, ependymoma. Pediatr Blood Cancer. 2021;68 Suppl 2:e28395. https://doi.org/10.1002/pbc.28395
- Bornhorst, M., Frappaz, D., & Packer, R. J. Pilocytic astrocytomas. Handbook of clinical neurology. 2016; 134:329–344. https://doi.org/10.1016/B978-0-12-802997-8.00020-7
- Marinoff, A. E., Ma, C., Guo, D. et al. Rethinking childhood ependymoma: a retrospective, multi-center analysis reveals poor long-term overall survival. Journal of neuro-oncology. 2017; 135(1):201–211. https://doi.org/10.1007/s11060-017-2568-8