[Central nervous system tumours in Icelandic children; diagnoses, treatment results and late effects.].
OBJECTIVE
Tumours in the central nervous system are the second most common malignant diseases in children. With improved treatment, the number of survivors is increasing. Therefore, better knowledge of the long-term effects of the disease and the therapy is needed. The aim of the current study was to find the incidence of central nervous system tumours in Iceland, evaluate the treatment results and study the long-term effects on the individuals.


METHODS
Data on diagnosis and treatment as well as demographic data were gathered from hospital records from the Reykjavik City Hospital and The University Hospital and operating lists at the Department of Neurosurgery were reviewed. On survivors, physical examination was carried out, blood tests and urine-analysis were done and hearing was tested. Social adaptation, school performance, memory, concentration and general well being were studied by a questionnaire.


RESULTS
In the years 1970-1995, 57 children, aged 16 and younger, were diagnosed in Iceland with central nervous system tumours, 30 girls and 27 boys. Two children with brain metastases were excluded. Of the 55 individuals, 38 are alive today, 19 girls and 19 boys. Seventeen children had astrocytoma, grade 1 or 2 and seven had astrocytoma of grade 3 or 4. Seven children had medulloblastoma, other tumours were less common. Four patients with benign tumours in the spine were excluded from the study; three are living abroad and three refused participation. Therefore, 28 patients were included in the further study, 15 males and 13 females. The mean age at diagnoses was 7 years and 8 months (7:8) (median 6:7 years, span 0:0-15:11), the mean age at study was 21:4 years (median 20:2 years, span 7:6-39:9) and the mean time from diagnosis until study was 12:8 years (median 11:5 years, span 2:5-26:3). The mean standard deviation score for height (SDS) was -0.63 at the time of study, five of the patients had SDS below two. Five individuals need hormone replacement therapy and one patient has scoliosis. Three patients have disabilities; two of those are incapable of activities of daily life. Three patients have hearing impairment; one of them is also blind. Of five patients who had seizures when diagnosed, two still have convulsions. Of 28 patients, twelve (43%) had learning difficulties in school and ten (36%) needed remedial teaching.


CONCLUSIONS
The incidence of central nervous tumours in Icelandic children is comparable to what has been reported in other countries. The results of the treatment are similar to what has been found in the other Nordic countries which maybe better than in other countries. The most prominent long-term effects among the survivors are endocrine dysfunctions and specific learning disabilities. Other, severe long-term complications are rare but have considerable effect on the individuals. We emphazise that organised, long-term follow-up is essential for these individuals, paying special attention to learning difficulties and endocrine dysfunction.
Hólm
Hilma
H
Children's Hospital, Landspitali University Hospital, Hringbraut, 101 Reykjavík, Iceland. asgeir@landspitali.is.
Jónsson
Olafur Gísli
OG
Thornórsson
Arni V
AV
Hannesson
Bjarni
B
Jónmundsson
Guðmundur Kr
GK
Kristinsson
Jón R
JR
Haraldsson
Asgeir
A