Razi Journal of Medical Sciences

    Background: Contrary to adults, primary and metastatic involvement of CNS is a rare condition in pediatric malignant tumors. With CNS involvement the prognosis will be poor and practical treatment modalities will decline so new approaches must be reviewed. The aim of this study was to find out the incidence of CNS involvement in different childhood malignancies. Also the survival analysis was determined.

Methods: This study is a cross-sectional project conducted on children with different extra CNS malignancies with metastases to CNS in a 10 year period from 1998 to 2008. These children were admitted in Hematology and Oncology ward of Hazrat-e-Ali Asghar Childrens hospital. CNS involvement was diagnosed by radiological (invasion of dura by tumor) or clinical evidences. Data were analyzed by Chi square and t-tests SPSS v> 17 was also used. P< 0.05 was considered as significant. Kaplan Mayer was  used for survival data analysis.

Results: A total of 414 patients with primary extra-CNS  malignancies including non-Hodgkin lymphoma(2 out of 46), Hodgkin  lymphoma(1 out of 75), Neuroblastoma(4 out of 87), Rhabdomyosarcoma(1 out of 58), Osteosarcoma(1 out of 36), Retinoblastoma(3 out of 63), Burkit lymphoma(3 out of 33), Rhabdoid tumor of kidney(1 out of 1) ,and Germ cell tumor of ovaries(1 out of 57) and totally 17 patient (4.1%) had CNS involvement. Mean age was 8.91± 4.4096 (1-19) years. Mean age during primary tumor diagnosis was 5.97 years and that of CNS involvement was 8.33 years. Mean time span between diagnosis of primary tumor and CNS involvement was 29.24 months (SD=34.296, Median+18, Range=2-120). In 17 patients with CNS metastasis, 52.9% were males and 47.1% were females. The most prevalent clinical manifestation was seizure (47.1 %) and the least one was back pain (5.9%). Overall survival was 50.7% (median time = 21.5 months) and for Progression survival was 64.7 %(median time =18 months). Mean survival  duration from diagnosis of CNS involvement till death was 2 months(SD=1.54919, Median=1, Range=1-6) and that of diagnosis of primary tumor  till death was 29.09 months(SD=35.10970, Median=19, Range=3-122). Finally there was 11 death reports (64.7%).

Conclusion: According to results, CNS metastases in children with extra –brain tumors are rare and their prediction is difficult.