ID #763 From Infancy to Adolescent and Young Adulthood(AYA): Age-Stratified Landscape of Brain Tumors in a Large LMIC Cohort Highlighting Fragmented Multidisciplinary Care and Opportunities for Improvement
Payal Malhotra, Sandeep Jain, Gauri Kapoor, Anjali Pahuja, Kaviraj Kaushik, Anila SharmaAbstract
Background
Brain tumor(BT) in children and adolescent and Young adults(AYA) show age-related heterogeneity, yet data on age-stratified incidence and multidisciplinary team (MDT)–based care from LMICs remain scarce.
Material and Methods
Single centre retrospective review of electronic medical records for demographic, clinico-pathologic, MDT care (neurosurgery, radiation and paediatric/medical oncology team participation at any point in time) and overall-survival (OS) data of patients aged <40 years with primary BTs between January 2014 - December 2024 from a tertiary referral centre in India.
Results
Among 641 patients, infants(<3 years) constituted 3%, children(3-14 years) 23%, and AYA (15-39 years)74%; predominantly from urban regions(87.2%) and male gender(68%). Median symptom duration prior to presentation was 30 days (range, 10days–5years). Medulloblastoma(47%) in infants and, gliomas(64%) in AYA were the most frequent diagnosis; 66% of all gliomas were high- grade likely due to referral bias. Tumor location varied by age: posterior fossa(children) vs, supratentorial(infants and AYA)(p = 0.02). Only 37%(243/641) underwent definitive treatment that did not vary by age. MDT care delivery remained inconsistent across different age groups 14% (p-value-0.001) with 17 % vs 0.4% in those seeking definitive treatment vs opinion (pvalue-0.001). However , medulloblastoma patients demonstrated highest utilization(37%, p = 0.006). The treated cohort had 2- and 5-year actuarial OS of 62% and 55%, respectively. On univariate analysis, diagnosis and tumor site influenced OS; however, only diagnosis remained significant on multivariate analysis (p = 0.001).
Conclusion
Our study reveals distinct age-stratified patterns of paediatric and AYA BTs presentation, low treatment uptake, urban bias, and substantial gaps in MDTcare highlighting critical opportunities to strengthen referral pathways, expand outreach to underserved rural populations, and institutionalize MDT workflows. This analysis resulted in establishment of paediatric/AYA neuro-oncology tumor board at our centre, representing a scalable model to improve equitable care and BT outcomes in LMIC setting.