Pediatric Craniopharyngioma Survival Outcomes at the U.S.-Mexico Border: Results from a Cross-Border Neuro-Oncology Program.

Abstract

Management of pediatric craniopharyngioma requires complex, multidisciplinary care. To improve survival for Mexican children with brain tumors at the U.S.-Mexico border, we established the Cross-Border Neuro-Oncology Program and facilitated access to high-complexity neuro-oncology care. We retrospectively assessed clinical and surgical characteristics and survival in U.S. and Mexican children with craniopharyngioma at Rady Children's Hospital, San Diego (RCHSD) between 2010 and 2022. Patients received follow-up care at RCHSD (RCHSD cohort) or Hospital General, Tijuana (HGT), Mexico (HGT cohort). Thirty-five children with craniopharyngioma were included: 30 patients (median age 8.7 years; interquartile range [5.1, 13.7], 60% male) in the RCHSD cohort and 5 patients (median age 14 years; interquartile range [7.0, 14.0], 20% male) in the HGT cohort. Children in the HGT cohort had longer symptom duration at presentation compared to the RCHSD cohort (24 weeks vs. 4 weeks; P = 0.011). Postdischarge endocrine care and compliance with endocrine treatment were lower in children in the HGT cohort versus RCHSD cohort (75% vs. 100%, P = 0.12, and 50% vs. 100%, P = 0.012, respectively). Overall survival was significantly lower in the HGT cohort compared to the RCHSD cohort (3-year: 80% vs. 100%, P = 0.016; 5-year: 53% vs. 100%, P = 0.003). Lack of postdischarge endocrine care was associated with lower overall survival in the HGT cohort versus RCHSD cohort (0% vs. 100%; P < 0.001). Despite providing access to complex neurosurgical care through the Cross-Border Neuro-Oncology Program for Mexican children with craniopharyngioma, survival was suboptimal. Delayed presentation and postoperative endocrine management will be addressed through infrastructure enhancements, engaging a pediatric endocrinologist at HGT, and providing training in early detection and management of complications.