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Risk factors in pediatric central nervous system tumors
Central nervous system (CNS) tumors are the first encountered solid tumor in pediatric oncology and represent an important therapeutic challenge for a multidisciplinar team. Brain tumors are diagnosed at any age; sign and symptoms are related to age, site and tumor growth. Histological features are important to classification (Bailey and Cushing, Kernohan, World Health Organisation) and prognosis. Aim of the present study was to find prognostic features of pediatric CNS tumors. We studied a group of 99 children diagnosed with CNS tumors between 1990 and 2008, 66 boys, 33 girls; 59.6% from rural areas. Median age at onset was 8 years and 5 months, without gender difference. Time of onset ranged from 4 hours to 2 years. There were 46 astrocytomas, 23 medulloblastomas, 17 ependymomas, 3 craniopharingiomas, 1 hipophiseal tumor and 9 other types of tumors. Onset symptoms included increased intracranial pressure (70 cases), neurological disorders (74 cases), visual disturbances (24 cases), seizures (7 cases), other symptoms (14 cases) and coma (2 cases). Surgical treatment was: total tumor resection (34 cases), subtotal resection (27 cases) and partial resection (19 cases); 6 cases underwent only tumoral biopsy, 8 cases did not undergo surgery. Median value of Erythrocite Sedimentation Rate (ESR) at onset – 17.00 mm/h. Median values of Fibrinogen (FG) at onset – 3.6150 g/L. Median value of Lacticdehidrogenosis (LDH) – 379.5 IU/L. Overall survival was variable, from less than 1 year in 34 cases, between 1 and 3 years in 19 cases and over 3 years in 46 cases. 50% of cases were dead in the first 3 years after diagnose. Analysis of survival according to ESR, FG and LDH showed no statistically significant differencies between them but between type of surgery and death is a direct relationship. Survival analysis for the event death according to age at onset revealed no significant differences between categories of patients ordered by age. Type of surgery seems to be the most important feature involved in prognosis in CNS tumors of children.
Key words: central nervous system tumors