SUBSEQUENT QUALITY-OF-LIFE FOR CHILDREN IRRADIATED FOR A BRAIN-TUMOR BEFORE AGE 4 YEARS

Background. We wanted to evaluate survival and functional morbidity fo llowing radiation treatment of brain tumors in children less than 4 ye ars old. Procedure. Outcome was evaluated for 222 children who were le ss than 4years old when they were irradiated at University of Toronto Centres, 1958-1995. The status of the survivors with regard to focal n eurological 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, occupat ion, and living arrangements. Results. The overall 10-year survival ra te was 40%, not significantly different than the 45% for 776 4-16-year -olds with irradiated brain tumors treated at the same institutions. F orty-five percent of the survivors had no major focal neurological, vi sual, or hearing defects. There were no major differences in the frequ encies of these criteria or of schooling between 0-2- and 2-4-year-old s. Among adult survivors, older than 21 at last follow-up, 26% success fully completed higher education, 31% were in full-time employment, an d 37% had never been employed. For medulloblastoma, the 5-year surviva l rate was 61% for 30 children less than 3 years old and treated from 1975-1995. This compared favorably with recent reports of survival fol lowing primary chemotherapy with delayed or omitted radiation treatmen t. Summary. Radiation treatment of a young child with a brain tumor wa s associated with cure in 1 of every 3 patients. Unfortunately, qualit y of life for many survivors was not good. Only one of every 3 adult s urvivors 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 treatmen t. Conclusions. The search for less toxic treatment remains appropriat e, but is experimental and researchers must recognize that there may b e a trade-off between morbidity and mortality. (C) 1998 Wiley-Liss, In c.