Jonathan Roth, Jehuda Soleman, Dimitris Paraskevopoulos,Robert F. Keating, Shlomi Constantini. Incidental brain tumors in children: an international neurosurgical, oncological survey. July 2018, Volume 34, Issue 7, pp 1325–1333. https://doi.org/10.1007/s00381-018-3836-4
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).
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.
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.
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.
In the current survey, we also addressed GHRT approval. Often, IPBT are diagnosed on MRI scans performed during evaluation of short stature. In the past, concern has been raised regarding the role of GHRT in recurrence or malignant transformation of brain tumors, especially among children. A recently published meta-analysis showed that the risk of recurrence or progression of children with intracranial tumors, such as craniopharyngioma, medulloblastoma, astrocytoma, and glioma, is not increased if they are treated with growth. In the current survey, during follow up of case 2, as long as the lesion remained stable, 25–35% of the responders approved GHRT. For case 5, following a stable period of 6 years, the oncologists were more permissive with GHRT compared to presentation. Thus, currently, there is need to reinforce the knowledge regarding potential risk of tumor progression and MT following GHRT.