Survival and functional outcome of children with hypothalamic/chiasmatic tumors.
BACKGROUND
The management of children with hypothalamic (H) and/or chiasmatic (C) tumors remains controversial. We evaluated the impact of clinical and neuroimaging parameters and primary therapy on overall (OS) and progression-free (PFS) survival and on neuroendocrine and neurocognitive outcome in children with H and/or C tumors.


METHODS
Records were reviewed for 73 children with H and/or C tumors treated at St. Jude Children's Research Hospital between October 1981 and December 1999.


RESULTS
Thirty-six patients received irradiation or chemotherapy immediately postdiagnosis and 37 were observed. The 6-year OS and PFS rates were 86 +/- 5%; and 36 +/- 7%, respectively. The 6-year PFS rates for the irradiation, chemotherapy, and observation groups were 69 +/- 16%, 12 +/- 11%, and 37 +/- 9%, respectively. In multivariate analysis, intracranial NF1 lesions (P = 0.015) and initial irradiation (P = 0.056) led to better PFS rates. There was no difference in OS between those initially treated or observed. Mean serial intelligence quotient (IQ) scores were 86 and 86 at diagnosis and at 6 years later, respectively. Patients younger than 5 years old had a lower mean IQ score at diagnosis (79.1) than older patients (96.3; P = 0.003). Patients who were irradiated at diagnosis had a significantly higher cumulative incidence of endocrinopathy at 3 years (P = 0.008).


CONCLUSIONS
Overall survival for children with H and/or C tumors is excellent. Initial treatment with radiation and the presence of intracranial NF1 lesions were positive predictors of PFS. Mean IQ is significantly compromised at diagnosis, but does not change over time or with irradiation. Overall survival is not affected by initial observation. We recommend observation in asymptomatic patients, platinum-based chemotherapy in younger patients, and irradiation in older symptomatic patients.
Fouladi
Maryam
M
Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. fouladi@stjude.org
Wallace
Dana
D
Langston
James W
JW
Mulhern
Raymond
R
Rose
Susan R
SR
Gajjar
Amar
A
Sanford
Robert A
RA
Merchant
Thomas E
TE
Jenkins
Jesse J
JJ
Kun
Larry E
LE
Heideman
Richard L
RL
D000293:Adolescent; D000367:Age Factors; D001254:Astrocytoma / Q000188:drug therapy / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D004700:Endocrine System Diseases / Q000209:etiology; D005260:Female; D005910:Glioma / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy*; D006801:Humans; D007029:Hypothalamic Neoplasms / Q000188:drug therapy* / Q000503:physiopathology / Q000532:radiotherapy*; D007223:Infant; D007361:Intelligence Tests; D008297:Male; D016896:Treatment Outcome