MB-91
OUTCOMES FOR YOUNG CHILDREN WITH BRAIN TUMOURS TREATED ACCORDING TO THE HEAD START PROTOCOLS: A SINGLE-CENTRE EXPERIENCE Free

INTRODUCTION: Young children with brain tumours at British Columbia Children's Hospital are commonly treated with radiation-sparing Head Start protocols. METHODS: This was a retrospective chart review. All patients treated on Head Start protocols from 1998-2011 [n = 37, 13 on-study, ages 0-93 months (median 28.6 months)] were identified from a clinical database and analyzed for treatment outcomes and late effects. RESULTS: Diagnoses included medulloblastoma (n = 18), ependymoma (n = 6), PNET (n = 5), ATRT (n = 3), high-grade glioma (n = 3), anaplastic DNET (n = 1) and high-grade neuroepithelial tumour (n = 1). Twelve of 37 (32%) patients had metastases at diagnosis. Sixty-two percent (n = 23) had gross total resections and 38% (n = 14) had post-operative residual. Four-year progression-free survival was 33%, radiation-free survival 39% and overall survival (OS) 56%. Forty-six percent (n = 17) relapsed, 22% (n = 8) progressed on therapy and there was one treatment-related death. Six of 25 progressions were salvaged with radiation and 3 without radiation, the remainder died. Two of three patients salvaged without radiation had high-grade gliomas that relapsed as low-grade gliomas. Overall survival was affected by the presence of CSF metastasis (13% vs. 66%, p = 0.01) but not underlying diagnosis or degree of upfront resection. Thirty-one of 33 patients (94%) with audiology results available had hearing loss. Among survivors, 60% have cognitive impairment and 30% have at least one endocrine deficit. CONCLUSIONS: Head Start chemotherapy cured one-third of treated patients. Only 36% of patients with relapse/progression were salvaged. Analysis of factors predicting survival was limited by sample size. Late effects were common among survivors.