Abstract The objectives of this study were to document the trajectory of children with CNS tumors at a tertiary-care, public-sector hospital in Pakistan. This prospective, analytic, cohort study recorded all new cases of suspected CNS tumors (birth to 16 years) who presented at Children’s Hospital Lahore from 2023/01/01 to 2023/12/31. A total of 145 cases were included. Median age at presentation was 7.0 years (1.5 months–15 years); male-to-female ratio was 1.4:1. Median time to presentation was 2 months (0.1 – 96 months); delay of 6 months was observed in 30.5% cases due to either delayed presentation to medical facility (74%) or healthcare delay (26%). Headaches and/or vomiting (56%), focal neurological deficits (23%), and seizures (15%) were the most common presenting complaints. First-degree consanguinity (46%), and family history of cancers/brain tumors (19%) were frequent; while café au lait macules were observed in 10% of cases. 50% of tumors were Infratentorial, 46% supratentorial and 4% spinal. Tumor excision was done in 45%, VP-shunts in 42%, and upfront chemotherapy was given in 2%. Only 60% reached a final diagnosis. Tissue diagnosis available in 39% of cases showed Medulloblastoma (18 patients, 32%), Pilocytic Astrocytoma (27%), and High-grade glioma (16%) as the commonest diagnoses. Radiological diagnosis in 21% of cases were DIPG/DMG (12%), Craniopharyngioma (7.6%), and Optic Pathway Glioma (1.4%). Of 18 medulloblastoma patients, 11 patients expired after surgery. Among the whole cohort of 145, 70 patients (48%) patients expired, including 38 before any surgery, 25% left against medical advice, and only 39 patients (27%) are on follow-up. One-year survival was 36% with a median survival of 4 months (0.07-96 months). It is concluded that notable diagnostic delay is not observed but the survival rate is dismal. Less than half of the patients with CNS tumors undergo active treatment, and a large proportion leave treatment/follow-up. A considerable number of cases with cancer predisposition syndromes were also suspected.
Ain et al. (Fri,) studied this question.