Brain Tumors of the First Years of Life: Ten Years IOP Experience

Introduction: Treatment strategies for patients with tumors in the first year of life is challenging. In spite of a high operative mortality, surgery still appears to be the more effective therapy. The postoperative chemotherapy is given in order to permit a delay in the delivery of radiation to developing brain or to enable more agressive surgeries in better clinical conditions.

Objective: To analyze the several treatment strategies and outcomes of brain tumors in patients up to 1 year of age in ten years of experience in a single institution.

Methods: The authors retrospectively evaluated 63 patients under 1 year of age with brain tumors treated between 2010 and 2017, at IOP/GRAACC/Unifesp. Data regarding initial clinical presentation, treatment modalities and outcomes were collected.

Results: From 63 patients under 1 year of age treated with brain tumors, 61 were elegible for evaluation and two were excluded for loss of follow-up. Thirty were girls, and 31, boys. The mean age at treatment was 6 months (range: 1 day-12 months). Twenty-nine babies presented with signs and symptons of intracranial hypertension, 11 babies with epileptic seizures, eight of them initially showed impairment of low cranial nerves. The other patients had other less frequent signs and symptoms. Forty-five tumors were located in the supratentorial compartment and 16 were infratentorially. Nine patients were diagnosed with tuberous sclerosis, two patients with neurofibromatosis type 1 (NF1), two diagnosed with Li-Fraumeni syndrome, and one with Gorlin syndrome. The patients with tuberous sclerosis and NF1 were treated clinically. The most common histological types were: 11 rhabdoid teratoid, nine low grade astrocytoma, five choroid plexus carcinoma and five glioblastoma. Surgery is the treatment of choice. Malignant tumors which could not be completely resected in only one surgery required other surgeries alternated with cycles of chemotherapy. Ten patients underwent more than one surgery (2 to 6 resections). Eight deaths occurred. The mean follow-up was 3y10m (range: 2 days-7y9m).

Conclusions: Gross total resection is the goal of surgical treatment, but sometimes this is impossible in the first approach. To decrease the high intraoperative mortality, these patients can undergo as many surgeries as necessary for total tumor resection.