ID #840 Bridging the Gap: A 20-Year Experience with Pediatric Ependymoma in a Low- and Middle-Income Setting
Alessandra Azambuja, Mariana Komatsu, Bianca Faria, Juliana Barreto, Lilian Cristofani, Jose Erasmo Col Lucio, Yuri CasalAbstract
Introduction
Patient outcomes for pediatric ependymoma in low- and middle-income countries (LMICs) are frequently compromised by resource limitations. This study analyzes clinical characteristics, treatment patterns, and outcomes at a single tertiary center over a 20-year period, with specific focus on the challenges associated with a resource-constrained setting.
Methods
A retrospective analysis was performed on medical records of all patients aged 0 to 18 years diagnosed with ependymoma between 2002 and 2022. Data included patient demographics, tumor histology and location, treatment modalities (surgery, radiotherapy, chemotherapy), and clinical outcomes. Overall survival (OS) was determined.
Results
Twenty-six patients were included, with a mean follow-up of 9.23 years. The mean age at diagnosis was 6 years and 11 months. Most tumors were infratentorial (57.7%), and anaplastic histology was identified in 38.5% of cases. Gross total resection (GTR) was achieved in 57.7% of patients. Radiotherapy was administered to 73.1% of patients, while 19% received chemotherapy, primarily for anaplastic or residual tumors. The relapse rate was 38.5%, and the 5-year overall survival was 83.3%. All deathsoccurred in patients with infratentorial tumors, and 75% of these cases did not achieve total resection. Significant long-term neurological and endocrinological sequelae were common, with only 20% of survivors free from sequelae.
Conclusion
This series demonstrates a favorable 5-year overall survival despite systemic challenges, such as the absence of routine molecular evaluation, lack of intraoperative MRI, and infrequent second-look surgeries due to high surgical demand and limited intensive care unit capacity. Delayed relapse diagnosis resulting from infrequent follow-up imaging and limited access to comprehensive rehabilitation further exacerbate these challenges. These findings highlight the significant impact of resource limitations on treatment and long-term morbidity, emphasizing the urgent need for investment in advanced diagnostics and supportive care to improve survival and quality of life for children with ependymoma in LMICs.