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Description
Brain and central nervous system tumors are the leading cause of death in children due to solid tumors. Quality treatment of these patients is a critical factor for increasing their chances of survival. Longitudinal population based studies have examined incidence and survival rates for children with brain and CNS tumors. However, less is known about the relationship between first course of treatment (e.g., surgery, chemotherapy, and radiation) and overall survival in childhood brain tumor patients. The purpose of this historical prospective study was to examine how demographic and treatment characteristics were associated with survival in children diagnosed with pilocytic astrocytoma (PA) and primitive neuroectodermal tumors (PNET). This study examined 1,679 children < 20 years of age diagnosed from 1988 to 2009 using the California Cancer Registry (CCR), a statewide, cancer surveillance registry. For PA and PNET patients, a majority were male (52.22% and 58.96%), 5 9 (29.77%) and 2 4 (30.67%) years of age and non Hispanic whites, (52.96% and 42.33), respectively. Tumor types were determined according to the International Classification of Diseases Oncology 3rd edition. Kaplan Meier survival estimates were used to examine survival rates and the differences between groups were examined using the log rank test. One , three , five , and 10 and 20 year survival rates were compared for demographic characteristics, tumor types, and treatment characteristics. Bivariate analyses were conducted for covariates using the accelerated failure time (ART) model and variables p < 0.2 were analyzed in multivariate analyses. Results indicated PA patients had an overall 5 year survival rate of 99.0% and PNET patients had a 5 year survival rate of 81.2%. No significant factors were associated with survival rates in PA patients. Several factors were associated with survival in PNET patients including age, tumor location, and treatment combination. PNET patients were 4.81 (95% CI 1.73, 13.46) times more likely to survive if their tumor was located in the cerebellum compared to the brain and cranial nerves (p = 0.0068), after controlling for other factors. PNET patients who received chemotherapy only were 0.02 (95% CI 0.00, 0.24) times as likely to survive compared to those who received surgery only (p = 0.0006), after controlling for other factors. Demographic characteristics, period of diagnosis and type of treatment facility were not significantly associated with survival in PA and PNET patients. These findings provide critical information about tumor and treatment characteristics that are associated with survival in children diagnosed with brain tumors. Future population based research should explore the grade, tumor size, extent of surgery (biopsy, partial resection, or total resection) and amount of radiation therapy (RT) to draw more specific conclusions about survival in children diagnosed with PA and PNET.
