Survival and Late Mortality in Long-Term Survivors of Pediatric CNS Tumors

2007 ◽  
Vol 25 (12) ◽  
pp. 1532-1538 ◽  
Author(s):  
E. Brannon Morris ◽  
Amar Gajjar ◽  
James O. Okuma ◽  
Yutaka Yasui ◽  
Dana Wallace ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Progressive Disease ◽  
Cns Tumors ◽  
Tumor Type ◽  
Cns Tumor ◽  
Late Mortality ◽  
Significant Difference ◽  
Long Term Survivors ◽  
Pediatric Cns Tumors

Purpose To describe the pattern of survival and late mortality among contemporary long-term survivors of pediatric CNS tumor. Patients and Methods The study population comprised 643 pediatric patients with primary CNS tumor treated at St Jude Children's Research Hospital (Memphis, TN) from 1985 to 2000 who survived ≥ 5 years from diagnosis. Patients were classified according to primary tumor type, location of tumor, and survival. Cause of death was obtained from the medical record and categorized as progression, malignant transformation, second malignancy, medical complication, or external cause. Results Overall survival estimates for patients who survived at least 5 years postdiagnosis was 91.3% ± 2% and 86% ± 3% at 10 and 15 years postdiagnosis, respectively. A significant difference in the survival rates according to original tumor type (P = .001) was seen. Sixty-six (10%) of 643 patients experienced late mortality: 38 patients (58%) died of progressive disease while 14 patients (21%) died of second malignant tumor. Twelve patients (18%), predominantly with diencephalic tumor location, died of a specific medical cause: cardiovascular disease (n = 2), cerebrovascular accident (n = 1), metabolic collapse and/or sepsis (n = 7), respiratory failure (n = 1), or shunt malfunction (n = 1). Conclusion Late mortality occurs in a substantial number of long-term survivors of pediatric CNS tumors and is most influenced by the initial tumor histopathology. Progressive disease remains the most common cause of death within the first decade of diagnosis. Teenage patients requiring treatment for panhypopituitarism may be especially vulnerable and deserve significant medical surveillance.

scholarly journals Long-Term Mortality after Histoplasma Infection in People with HIV

2021 ◽  
Vol 7 (5) ◽  
pp. 369
Author(s):  
Joseph Cherabie ◽  
Patrick Mazi ◽  
Adriana M. Rauseo ◽  
Chapelle Ayres ◽  
Lindsey Larson ◽  
...  
Keyword(s):  
Statistical Significance ◽  
Modern Art ◽  
Private Insurance ◽  
Early Mortality ◽  
Late Mortality ◽  
Significant Difference ◽  
Common Opportunistic Infection ◽  
Long Term Survivors ◽  
Long Term Mortality

Histoplasmosis is a common opportunistic infection in people with HIV (PWH); however, no study has looked at factors associated with the long-term mortality of histoplasmosis in PWH. We conducted a single-center retrospective study on the long-term mortality of PWH diagnosed with histoplasmosis between 2002 and 2017. Patients were categorized into three groups based on length of survival after diagnosis: early mortality (death < 90 days), late mortality (death ≥ 90 days), and long-term survivors. Patients diagnosed during or after 2008 were considered part of the modern antiretroviral therapy (ART) era. Insurance type (private vs. public) was a surrogate indicator of socioeconomic status. Out of 54 PWH infected with histoplasmosis, overall mortality was 37%; 14.8% early mortality and 22.2% late mortality. There was no statistically significant difference in survival based on the availability of modern ART (p = 0.60). Insurance status reached statistical significance with 38% of survivors having private insurance versus only 8% having private insurance in the late mortality group (p = 0.05). High mortality persists despite the advent of modern ART, implicating a contribution from social determinants of health, such as private insurance. Larger studies are needed to elucidate the role of these factors in the mortality of PWH.

scholarly journals LINC-14. TREATMENT OF PEDIATRIC CNS TUMORS IN ARMENIA. 10 YEARS OF EXPERIENCE IN A 29 YEARS OLD RESOURCE-LIMITED SETTING

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii381-iii381
Author(s):  
Martin Harutyunyan ◽  
Lilit Sargsyan ◽  
Samvel Iskanyan ◽  
Lusine Hakobyan ◽  
Ruzanna Papyan ◽  
...  
Keyword(s):  
Pilocytic Astrocytoma ◽  
Pediatric Brain Tumors ◽  
Cns Tumors ◽  
Optic Pathway Glioma ◽  
Childhood Malignancies ◽  
Resource Limited ◽  
Medical University ◽  
Long Term Survivors ◽  
Pediatric Cns Tumors

Abstract BACKGROUND Pediatric CNS tumors are the most common solid childhood malignancies with many challenges facing optimal outcome due to multimodality complex therapies, abandonment, and long-term morbidity. In our three-decades young, country the field of neuro-oncology is in its infancy. MATERIALS: The aim of our study is to assess incidence, epidemiology and treatment outcomes of children diagnosed and treated with CNS tumors within the last 10 years (2009–2019) in the Chemotherapy Clinic of “Muratsan” Hospital Complex of Yerevan State Medical University. RESULTS During these periods 20 patients with CNS tumors were treated in our clinic. 13 patients (65%) were diagnosed with medulloblastoma (2 patients were infants), two patients (10%) with optic pathway glioma, and 5 patients each with pilocytic astrocytoma, ATRT, ETANTR, DIPG, and glioblastoma. Five patients (3 patients with medulloblastoma, 1 patient with pilocytic astrocytoma, 1 patient with ATRT) had metastatic disease at the time of diagnosis. Seventeen patients (80%) had undergone surgery, 8 patients with medulloblastoma received chemo-RT with vincristine. Median follow up time was 15.5 months (range 5–94). Twelve patients (60%) are alive without evidence of disease. 5 patients had disease progression and three patients relapsed. From them, 3 patients died. Long-term survivors are mainly standard risk medulloblastoma patients. All medulloblastoma patients were treated according to HIT-MED guidelines. CONCLUSION Here we report about the pediatric brain tumors of one of the main pediatric oncology units in Armenia for a period of 10 years. The numbers are quite small for firm conclusions, but it shows the emerging need for further research.

Aggressive Treatment in Glioblastoma: What Determines the Survival of Patients?

2020 ◽  
Author(s):  
Lei Yu ◽  
Guozhong Zhang ◽  
Songtao Qi
Keyword(s):  
Overall Survival ◽  
Malignant Gliomas ◽  
Epidemiological Studies ◽  
Control Cohort ◽  
Poor Overall Survival ◽  
Term Survival ◽  
Significant Difference ◽  
Positive Rate ◽  
Long Term Survivors

Abstract Background and Study Aims The exact reason of long-term survival in glioblastoma (GBM) patients has remained uncertain. Molecular parameters in addition to histology to define malignant gliomas are hoped to facilitate clinical, experimental, and epidemiological studies. Material and Methods A population of GBM patients with similar clinical characteristics (especially similar resectability) was reviewed to compare the molecular variables between poor (overall survival [OS] < 18 months, control cohort) and long-term survivors (overall survival > 36 months, OS-36 cohort). Results Long-term GBM survivors were younger. In the OS-36 cohort, the positive rate of isocitrate dehydrogenase (IDH) mutation was very low (7.69%, 3/39) and there was no statistical difference in OS between IDH mutant and wild-type patients. The results of 1p/19q codeletions are similar. Besides, there were no significant difference in MGMT promoter methylation, telomerase reverse transcriptase (TERT) promoter mutation, and TP53 mutations between OS-36 cohort and control cohort. Conclusions No distinct markers consistently have been identified in long-term survivors of GBM patients, and great importance should be attached to further understand the biological characteristics of the invasive glioma cells because of the nature of diffuse tumor permeation.

Quality of life in long-term survivors of CNS tumors of childhood and adolescence.

1991 ◽  
Vol 9 (4) ◽  
pp. 592-599 ◽  
Author(s):  
E N Mostow ◽  
J Byrne ◽  
R R Connelly ◽  
J J Mulvihill
Keyword(s):  
Quality Of Life ◽  
Late Effects ◽  
Pediatric Brain Tumor ◽  
Adverse Outcomes ◽  
Cns Tumors ◽  
Childhood And Adolescence ◽  
Long Term Survivors

Clinical reports of small numbers of pediatric brain tumor patients observed for brief periods suggest that long-term survivors continue to have major handicaps into adulthood. To quantify these late effects we interviewed 342 adults (or their proxies) who had CNS tumors diagnosed before the age of 20 between 1945 and 1974, survived at least 5 years, and reached 21 years of age. Survivors were 32 years old on average at follow-up. When compared with 479 matched siblings as controls. CNS tumor survivors were more likely to have died or to have become mentally incompetent sometime during the follow-up period. They were more likely to be at risk for such adverse outcomes as unemployment (odds ratio [OR], 10.8; 95% confidence interval [CI], 4.6 to 25.7], to have a health condition that affected their ability to work (OR, 5.9; CI, 3.7 to 9.4), to be unable to drive (OR, 28.8; CI, 6.9 to 119.9), or to describe their current health as poor (OR, 7.8; CI, 1.7 to 35.7). Unfavorable outcomes were more frequent in male survivors than in females, in those with supratentorial tumors compared with infratentorial ones, and in those who received radiation therapy. As clinicians consider improving therapies, they should anticipate late effects, such as those we observed, and attempt to target subgroups for interventions that may improve subsequent quality of life.

scholarly journals Late Mortality and Causes of Death among Long-Term Survivors after Allogeneic Stem Cell Transplantation

2016 ◽  
Vol 22 (9) ◽  
pp. 1702-1709 ◽  
Author(s):  
Yoshiko Atsuta ◽  
Akihiro Hirakawa ◽  
Hideki Nakasone ◽  
Saiko Kurosawa ◽  
Kumi Oshima ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Allogeneic Stem Cell Transplantation ◽  
Causes Of Death ◽  
Late Mortality ◽  
Long Term Survivors

Chemotherapy of pediatric brain-stem tumors

1981 ◽  
Vol 54 (6) ◽  
pp. 721-725 ◽  
Author(s):  
Dorcas S. Fulton ◽  
Victor A. Levin ◽  
William M. Wara ◽  
Michael S. Edwards ◽  
Charles B. Wilson
Keyword(s):  
Tumor Progression ◽  
Brain Stem ◽  
San Francisco ◽  
Low Grade ◽  
Content Type ◽  
Tumor Pathology ◽  
Significant Difference ◽  
Brain Stem Tumors ◽  
Long Term Survivors

✓ Forty-five children harboring brain-stem tumors were treated at the University of California, San Francisco, between 1969 and 1979. Pathological diagnoses were made in 19 patients. All patients received radiation therapy (RT). Thirteen patients received chemotherapy before, during, or immediately after RT. Twenty-four patients were treated with chemotherapy at the time of tumor progression, after initial treatment with RT alone. No statistically significant difference in time to tumor progression or survival was found for treatment with chemotherapy as an adjuvant to RT compared to treatment with RT alone followed by chemotherapy administered at the time of tumor progression. There were, however, more long-term survivors in the group that was first treated with chemotherapy at the time of tumor progression. There was no statistically significant correlation between survival and tumor pathology or location, although there were more long-term survivors among patients harboring low-grade gliomas and among patients with tumors confined to the midbrain. The authors documented the response of some brain-stem tumors to chemotherapy; however, cooperative controlled studies will be required to determine the optimum treatment for this disease.

Smell and Taste Impairment After Total Laryngectomy

2017 ◽  
Vol 126 (7) ◽  
pp. 548-554 ◽  
Author(s):  
Giuseppe Riva ◽  
Matteo Sensini ◽  
Andrea Corvino ◽  
Giancarlo Pecorari ◽  
Massimiliano Garzaro
Keyword(s):  
Multivariate Analysis ◽  
Total Laryngectomy ◽  
Taste Strips ◽  
Control Subjects ◽  
Significant Difference ◽  
Identification Threshold ◽  
Long Term Survivors ◽  
Tdi Score

Objective: Aim of this observational study is the evaluation of olfactory and gustatory impairments in laryngectomized long-term survivors compared to control subjects. Correlation between smell and taste alterations, age, and previous adjuvant treatments in laryngectomees was investigated. Methods: Fifty control subjects and 50 patients who underwent total laryngectomy for advanced laryngeal carcinoma were evaluated. All subjects underwent symptoms evaluation, oropharyngeal exam, endoscopic fiberoptic nasal examination, and Taste Strips and Sniffin’ Sticks tests. Results: Hyposmia was reported by all laryngectomees and hypogeusia by 54% of patients. Sniffin’ Sticks and Taste Strips tests demonstrated a statistically significant difference between controls and laryngectomees regarding olfactory threshold, odor discrimination and identification, Threshold Discrimination Identification (TDI) score, and sour, salty, and gustatory Total Taste score ( P < .05). Multivariate analysis for Total Taste score in laryngectomees showed a statistically significant correlation with aging, having an odds ratio of 0.127 for age ≥65 years, but not with TDI score, radiotherapy, and follow-up time, whereas multivariate analysis for TDI score demonstrated no correlation with radiotherapy, age, and follow-up time. Conclusions: Total laryngectomy determines olfactory and gustatory impairments that should be taken into account in clinical practice. Relationships between sensorial alterations, aging, follow-up period, and adjuvant treatments should be further evaluated in prospective studies.

scholarly journals Incidence Rates of Pediatric Central Nervous Tumors Display No Geographical Variation

2021 ◽  
Author(s):  
Dayton P Grogan ◽  
Vamsi Reddy ◽  
Christopher Banerjee ◽  
Jennifer Waller ◽  
Theodore Johnson ◽  
...  
Keyword(s):  
United States ◽  
Statistical Significance ◽  
The United States ◽  
Fold Change ◽  
Cns Tumors ◽  
Tumor Type ◽  
United States Census Bureau ◽  
Cns Tumor ◽  
Geographical Regions ◽  
Small Effect Size

Background: Central nervous system (CNS) tumors affect over 4,600 children throughout the United States each year. Despite recent trends of increasing incidence of pediatric CNS tumors, the understanding of variations in their incidence between different geographical regions remains incomplete. Methods: Data used in this study was obtained from the Surveillance, Epidemiology, and End Results (SEER) Program. The SEER database and its built-in operation software was used to generate state-specific incidence data for newly diagnosed CNS tumor diagnoses in children ages 0-19 for the years 2001-2014. Results were organized by tumor type and individual states were clustered into nine geographical regions as defined by the United States Census Bureau. Results: Statistically significant differences were found in the regional incidence of astrocytoma, primitive neuroectodermal tumor (PNET), and the category of unspecified intracranial and intraspinal neoplasms. However, the magnitude of the difference in incidence (ΔI) between specific regions was small, on the order of 0.1 to 0.6 per 100,000 population, representing a nominal 0.05-fold to 0.79-fold change in incidence (ΔI/incidence for comparator region) for astrocytoma and for the category of unspecified intracranial and intraspinal neoplasms, and a larger 3.25-fold to 3.75-fold change in incidence for PNET. Conclusions: Differences in incidence between geographical regions for certain CNS tumor types met the bar for statistical significance. However, these differences are unlikely to be clinically meaningful due to the small effect size.

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