Long-term survival of children with brain tumors.

Outcome is described for 1,034 children who received radiation treatment in the management of a brain tumor at the University of Toronto Institutions from 1958 to 1995. The 5-, 10-, 20-, and 30-year relapse-free (or progression-free) survival rates were 47%, 45%, 44%, and 44%, respectively, whereas the corresponding overall survival rates were 52%, 44%, 38%, and 30%. Second malignant tumors became an important cause of death over time, with cumulative incidences of 2.5%, 13%, and 19% at 10, 20, and 30 years, respectively. The 5-year survival rate after the diagnosis of a second malignant tumor was 58%. In general, high-grade tumors, eg, high-grade astrocytomas or brainstem tumors, had a poor 20-year survival rate (18%), compared with low-grade tumors (39% to 47%). Despite improvements in imaging, neurosurgical technique, and radiation treatment, children treated during the last 20 years did not have a significantly improved outcome when compared to children treated earlier.