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Delayed diagnosis of childhood low-grade glioma: causes, consequences, and potential solutions

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Abstract

Purpose

Diagnosis of childhood brain tumors is delayed more than diagnosis of other pediatric cancers. However, the contribution of the most common pediatric brain tumors, lowgrade gliomas (LGG), to this delay has never been investigated.

Methods

We retrospectively reviewed cases of childhood LGG diagnosed from January 1995 through December 2005 at our institution. The pre-diagnosis symptom interval (PSI) was conservatively calculated, and its association with race, sex, age, tumor site, tumor grade, and outcome measures (survival, disease progression, shunt use, seizures, extent of resection) was analyzed. Cases of neurofibromatosis type 1 were reported separately.

Results

The 258 children had a median follow-up of 11.1 years, and 226 (88 %) remained alive. Greater pre-diagnosis symptom interval (PSI) was significantly associated with grade I (vs. grade II) tumors (p = 0.03) and age >10 years at diagnosis (p = 0.03). Half of the 16 spinal tumors had a PSI > 6 months. PSI was significantly associated with progression (p = 0.02) in grade I tumors (n = 195) and in grade I tumors outside the posterior fossa (n = 134, p = 0.03). Among children with grade I tumors, median PSI was longer in those who had seizures (10.3 months) than in those who did not (2.5 months) (p = 0.09).

Conclusions

Delayed diagnosis of childhood LGG allows tumor progression. To reduce time to diagnosis, medical curricula should emphasize inclusion of LGG in the differential diagnosis of CNS neoplasm.

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Acknowledgments

This work was supported by Cancer Center Support Grant CA21765 and Pediatric Oncology Program Support Grant CA02394 from the National Cancer Institute and by the American Lebanese Syrian Associated Charities (ALSAC). The authors thank Sharon Naron for editing the manuscript.

Conflict of interest

The authors state that they have no conflicts of interest to disclose, financial or otherwise. This retrospective study was approved by the St. Jude Children’s Research Hospital Institutional Review Board, which waived the requirement for informed consent.

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Author notes

  1. Aska Arnautovic

    Present address: George Washington University, 2121 I St NW, Washington, DC, 20052, USA

Authors and Affiliations

  1. Pediatric Oncology Education Program, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Aska Arnautovic

  2. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Catherine Billups

  3. Department of Oncology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, USA

    Alberto Broniscer, Amar Gajjar & Ibrahim Qaddoumi

  4. Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, 38105, USA

    Frederick Boop

  5. Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN, 38105, USA

    Alberto Broniscer, Amar Gajjar & Ibrahim Qaddoumi

Authors
  1. Aska Arnautovic
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  2. Catherine Billups
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Corresponding author

Correspondence to Ibrahim Qaddoumi.

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Arnautovic, A., Billups, C., Broniscer, A. et al. Delayed diagnosis of childhood low-grade glioma: causes, consequences, and potential solutions. Childs Nerv Syst 31, 1067–1077 (2015). https://doi.org/10.1007/s00381-015-2670-1

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  • DOI: https://doi.org/10.1007/s00381-015-2670-1

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