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