ID #973 CNS Tumors in the First Three Years of Life: Real-World Perspectives from Pakistan’s Largest Public Sector Referral Center

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Abstract Background and Objectives Central nervous system (CNS) tumor under three years of age is particularly challenging due to the developing brain and limited resources. This study aimed to describe the demographic profile, clinical characteristics, treatment patterns, and survival outcomes of children under three years diagnosed with CNS tumors at a largest public-sector referral center in Pakistan. Methods This prospective, observational cohort study included all newly diagnosed CNS tumors in children from birth to three years presenting between January 1, 2023, and December 31, 2025. Data were recorded prospectively and summarized using descriptive statistics. Results A total of 115 patients were included, with a mean age of 1.92 ± 0.90 years and a male-to-female ratio of 1.4:1. Twenty-four percent traveled over 600 km for care, and the median monthly household income was USD 90 (range, USD 20–1000). The median diagnostic delay was 2.0 months (IQR 1.0–4.0), attributed to healthcare-related delay in 21% and patient-related delay in 36%, while 43% presented within one month. Common presenting symptoms included vomiting (24%), focal neurological deficits (21%), and motor regression or delay (12%). Consanguinity was present in 36%, family history of cancer in 11%, and neurocutaneous stigmata in 10%. Tumors were Infratentorial in 49%, Supratentorial in 46%, and Spinal in 5%, with the cerebellum being the most common primary site (42%). Surgical excision was performed in 30% of patients. Among histologically confirmed cases, low-grade glioma was most frequent (26%), followed by embryonal tumors (21%) and Ependymoma (19%). The median time to surgery or treatment initiation was 0.9 months (IQR 0.5–2.0). At data cutoff, 40% were lost to follow-up, 39% had died, and only 8% were on post-treatment follow-up. Median event-free survival was 1.5 months (IQR 0.0–5.0), with an overall survival rate of 21%. Survivors demonstrated good functional outcomes, with a median Lansky performance score of 100 (IQR 80–100). Conclusion In children under three years with CNS tumors, access to definitive treatment remains limited, with high attrition contributing to poor survival. Survivors who complete therapy demonstrate excellent performance status. Strategies addressing diagnostic delay, capacity-building, treatment abandonment, and possible cancer predisposition are urgently needed in resource-limited settings.

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