Subsequent quality of life for children irradiated for a brain tumor before age four years.
BACKGROUND
We wanted to evaluate survival and functional morbidity following radiation treatment of brain tumors in children less than 4 years old.


METHODS
Outcome was evaluated for 222 children who were less than 4 years 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.


CONCLUSIONS
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.
Jenkin
D
D
Toronto-Sunnybrook Regional Cancer Centre, Ontario, Canada.
Danjoux
C
C
Greenberg
M
M
D001254:Astrocytoma / Q000503:physiopathology / Q000532:radiotherapy; D001932:Brain Neoplasms / Q000503:physiopathology* / Q000532:radiotherapy*; D002675:Child, Preschool; D004806:Ependymoma / Q000503:physiopathology / Q000532:radiotherapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D008527:Medulloblastoma / Q000503:physiopathology / Q000532:radiotherapy; D011788:Quality of Life; D016019:Survival Analysis