Jonathan Roth1, Jehuda Soleman2,3, Dimitris Paraskevopoulos4,5, Robert F Keating6, Shlomi Constantini2. 1. Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel. jonaroth@gmail.com. 2. Department of Pediatric Neurosurgery, Dana Children's Hospital, Tel Aviv Medical Center, Tel Aviv University, 6 Weizman Street, 64239, Tel Aviv, Israel. 3. Department of Neurosurgery, Division of Pediatric Neurosurgery, University Hospital and Children's Hospital of Basel, Basel, Switzerland. 4. Department of Neurosurgery, Barts Health NHS Trust, St. Bartholomew's and The Royal London Hospital, London, UK. 5. Blizard Institute, Barts and The London School of Medicine, Queen Mary University London, London, UK. 6. Departments of Neurosurgery and Pediatrics, Children's National Medical Center, Washington DC, USA.
Abstract
PURPOSE: Incidental pediatric brain tumors (IPBT) are increasingly being diagnosed. Currently, there is no consensus regarding the need and timing of their treatment. In the current study, we identify trends among pediatric neurosurgeons and oncologists with regard to IPBT management and approval of growth hormone replacement therapy (GHRT). METHODS: A questionnaire presenting six different cases of IPBT was emailed to all members of several leading societies in pediatric neurosurgery and oncology. Collected data included basic information concerning the responders (profession, experience, continent of practice), as well as responses to multiple questions regarding treatment of the lesion, permission to supply GHRT, and free text for comments. RESULTS: One hundred forty-three responses were eligible for analysis (92 neurosurgeons, 51 oncologists, from a total of 6 continents). Initial recommendations for each case were heterogeneous. However, a few consistent trends were identified: Lesions that were stable over time lead to a common shift in treatment recommendation to a more conservative one. Growing lesions were commonly treated more aggressively. Neither profession nor experience had a consistent impact on recommendations. CONCLUSIONS: Management recommendations for IPBT varied among the responders and seem to be influenced by many factors. However, stable lesions lead to a shift in management towards a "watch and wait" approach, while in growing lesions responders tended towards a "biopsy" or "resection" approach. This highlights the need for better understanding of the natural course of incidental brain tumors in children, as well as evaluating the potential risk for malignant transformation.
PURPOSE: Incidental pediatric brain tumors (IPBT) are increasingly being diagnosed. Currently, there is no consensus regarding the need and timing of their treatment. In the current study, we identify trends among pediatric neurosurgeons and oncologists with regard to IPBT management and approval of growth hormone replacement therapy (GHRT). METHODS: A questionnaire presenting six different cases of IPBT was emailed to all members of several leading societies in pediatric neurosurgery and oncology. Collected data included basic information concerning the responders (profession, experience, continent of practice), as well as responses to multiple questions regarding treatment of the lesion, permission to supply GHRT, and free text for comments. RESULTS: One hundred forty-three responses were eligible for analysis (92 neurosurgeons, 51 oncologists, from a total of 6 continents). Initial recommendations for each case were heterogeneous. However, a few consistent trends were identified: Lesions that were stable over time lead to a common shift in treatment recommendation to a more conservative one. Growing lesions were commonly treated more aggressively. Neither profession nor experience had a consistent impact on recommendations. CONCLUSIONS: Management recommendations for IPBT varied among the responders and seem to be influenced by many factors. However, stable lesions lead to a shift in management towards a "watch and wait" approach, while in growing lesions responders tended towards a "biopsy" or "resection" approach. This highlights the need for better understanding of the natural course of incidental brain tumors in children, as well as evaluating the potential risk for malignant transformation.
Authors: Jonathan Roth; Robert F Keating; John S Myseros; Amanda L Yaun; Suresh N Magge; Shlomi Constantini Journal: J Neurosurg Pediatr Date: 2012-07-20 Impact factor: 2.375
Authors: Jeffrey H Wisoff; Robert A Sanford; Linda A Heier; Richard Sposto; Peter C Burger; Allan J Yates; Emiko J Holmes; Larry E Kun Journal: Neurosurgery Date: 2011-06 Impact factor: 4.654
Authors: G L O Lima; E Dezamis; R Corns; O Rigaux-Viode; S Moritz-Gasser; A Roux; H Duffau; J Pallud Journal: Neurochirurgie Date: 2017-02-01 Impact factor: 1.553
Authors: Michael Opoku-Darko; Stefan T Lang; James Artindale; J Gregory Cairncross; Robert J Sevick; John J P Kelly Journal: J Neurosurg Date: 2017-10-06 Impact factor: 5.115
Authors: Jonathan Roth; E Steve Roach; Ute Bartels; Sergiusz Jóźwiak; Mary Kay Koenig; Howard L Weiner; David N Franz; Henry Z Wang Journal: Pediatr Neurol Date: 2013-10-15 Impact factor: 3.372