EPIDEMIOLOGICAL PATTERNS OF PAEDIATRIC BRAIN TUMORS IN COIMBATORE

Background: Tumors of the nervous system are the second most common childhood tumors after leukemia,constituting approximately 35% of all childhood malignancies and remain the leading cause of cancer related deaths in children. In India,in the absence of a comprehensive population based national cancer registry,we depend on local hospital based registries for assessing the incidence of pediatric brain tumor.Hence,more and more institutional data are required to assess the actual disease load in India. Objective : The main objective of the present study is to assess the epidemiological patterns of brain tumors in children presenting in CMCH. Materials and Methods: Data regarding age,gender,topography and histopathology of 22 pediatric patients (0-18years)with brain tumors operated inCMCH over a period of 5 years(January 2015 to December 2019)was collected retrospectively and analysed. The results obtained were compared with available Indiandata and western literature.

Background: Tumors of the nervous system are the second most common childhood tumors after leukemia,constituting approximately 35% of all childhood malignancies and remain the leading cause of cancer related deaths in children. In India,in the absence of a comprehensive population based national cancer registry,we depend on local hospital based registries for assessing the incidence of pediatric brain tumor.Hence,more and more institutional data are required to assess the actual disease load in India. Objective: The main objective of the present study is to assess the epidemiological patterns of brain tumors in children presenting in CMCH. Materials and Methods: Data regarding age,gender,topography and histopathology of 22 pediatric patients (0-18years)with brain tumors operated inCMCH over a period of 5 years(January 2015 to December 2019)was collected retrospectively and analysed. The results obtained were compared with available Indiandata and western literature. Results: Of 22 cases, males(63.6%) outnumbered females. In the present study, the most common anatomical site for brain tumors was cerebellum(45.5%) followed by cerebral hemispheres(36.2%), ventricles(13.6%) and sellar region(4.5%). The present study showed that Infratentorial tumors were more common (54.5%) as compared to Supratentorial tumors (45.5%).Thepresent study revealed that astrocytoma(36.4%) is the most common brain tumor in childhood. other common tumors include medulloblastoma(27.2%), followed by ependymoma(13.6%), oligodendroglioma(9%),pineal gland tumor(4.5%),craniopharyngioma(4.5%) and meningeal tumor(4.5%). Conclusion: From the present series, we conclude that, the frequencies of major histologic types of brain tumors found in the study do not differ substantially from that found in other developed and developing countries. Medulloblastomas and astrocytomas, which form the major histologic types in pediatric patients need special attention.

ISSN: 2320-5407
Int. J. Adv. Res. 9(09), 891-896 892 Introduction:-Tumors of the nervous system are the second most common childhood tumor after leukemia, [l] constituting approximately 35% of all childhood malignancies and remain the leading cause of cancer related death in children. [2]Childhood central nervous system (CNS) tumors differ significantly from adult brain tumors in reference to their sites of origin, clinical presentation, tendency to disseminate early, histological features and their biological behavior. Whereas in adults the predominant CNS tumor types are metastasis, glial neoplasms and meningiomas. In children, besides gliomas, other major tumor types including primitive embryonal neoplasms. In recent times, an enhanced understanding of these biological differences between adult and childhood CNS neoplasms has led to investigations in distinct molecular and genetic pathways and therapeutic approaches for each tumor type. However, for the necessary research required in the field of pediatric brain tumors, a thorough knowledge of the worldwide incidence and distribution of the various neoplasms is essential.
Even though there are enough data about the epidemiology of pediatric brain tumors in western population, there are only a few reports from developing countries like India. According to the Indian Council of Medical Research, National Cancer Registry data, the incidence of pediatric brain tumors ranges from 0% to 2.11%. [1] In a recent multi-institutional study from seven prestigious tertiary care centers spread across India, pediatric central nervous system tumors accounted for on an average of 14.8% (10%-21%) of total intracranial tumors. [3] In India, in the absence of a comprehensive population-based national cancer registry, we depend on local hospital-based registries for assessing the incidence of pediatric brain tumors. [4] Hence, more and more institutional data are required to assess the actual disease load in India. These data are also essential for developing proper infrastructure among various cancer centers spread across india and provide insight into geographical variation in subtype and biology of these tumors. The main objective of present study is to access the epidemiological patterns of brain tumor in children in Coimbatore medical college hospital (CMCH).

Aims And Objective of Study:-
To analyze the epidemiological patterns of brain tumor in children in CMCH.

Material and Method:-
This is a retrospective, observational study. The medical records of children <18years registered in department of neurosurgery, CMCH from January 2015 to December 2019 diagnosed as primary brain tumors were retrieved from neuropathology records. Primary tumors of the brain were included, while metastatic tumors <18 years of age and vascular malformations were excluded. Data regarding age, gender, topography, and histopathology of 22 pediatric patients (0-18 years) with brain tumors operated over a period of 5 years (January 2015 to December-2019) was collected retrospectively and analyzed. The results obtained were compared with available Indian data and western literature.

Supratentorial and Infratentorial
The present study showed that Infratentorialtumors were more common (54.5%) as compared to Supratentorialtumors (45.5%).

Histological Distribution
The percentage of various types of brain tumors in each age group is given in the table below. Medulloblastoma was the most common histology in 0-5 years age group, whereas in 6-10 years age groups, astrocytoma was the predominant histologic type. Discussion:-Pediatric brain tumors are a heterogeneous group of neoplasms which varies in their cell of origin, clinical features, treatment strategies, and clinical outcomes. Even though significant advances are made in the management of many other pediatric malignancies, pediatric brain tumors still pose a tough challenge to oncologists worldwide.

Percentage of various histologic types of brain tumors in 0-5 age group
In developing countries like India, due to lack of complete registration of newly diagnosed cases with local cancer registries, the exact tumor burden of such diseases goes unnoticed and is underestimated. Hospital-based prevalence data therefore forms the basis for estimating the disease load. This data is essential for ascertaining the required healthcare infrastructure in the management of these diseases, and for assessing geographical differences in their molecular and genetic profiles. With increased availability of diagnostic facilities and better healthcare, the incidence of CNS tumors seems to be on the rise in developing countries In our study, the most common brain tumors in the pediatric age group in descending order are astrocytoma, medulloblastoma, followed closely by ependymoma. In western population, it was found that astrocytomas and medulloblastomas are the two most common brain tumors in children. These tumors are the most common tumors in our study too. Various studies from Asian centers also confirm these data. Another interesting observation is that ependymoma is the third most common childhood brain tumor in various Western studies from Germany, [5] Canada, [6] Sweden, [7] and Morocco. [8] In the present study too, ependymoma is the third most common brain tumor. On the contrary, craniopharyngioma is the third most common tumor in various Asian studies from Korea, [9] Beijing, [10] Japan, [11] and also in a large multi-institutional study from India. Though this was a hospital-based study with small cohort and data collection was restricted to short duration, results were comparable to those observed in other mentioned hospital-based and population-based studies. The current study is a single tertiary care center study and needs cautious interpretation. The population-based studies are required to study the demographics and determine the burden of CNS malignancies among the pediatric patients in India. This is only possible if regional cancer registries are maintained meticulously.

Conclusion:-
From the present series, we conclude that, the frequencies of major histologic types of Pediatric brain tumors found in the study do not differ substantially from that found in other developed and developing countries except for slightly higher frequency of oligodendroglioma. Medulloblastomas and astrocytomas, which form the major histologic types in pediatric patients need special attention. Epidemiological surveillance of various histological types of Pediatric brain tumors is of great importance from public health perspective. It helps in planning the distribution of infrastructure and resources toward the disease management and preventive programs. In countries like India where there is a scarcity of data because of inadequacies in tumor registration, such hospital-based studies have a major role to play in such planning.