Improving Outcomes in Paediatric Patients With Posterior Fossa Tumours: The Rapid Assessment Pathway in Resource-Limited Settings.
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INTRODUCTION: Posterior fossa tumours present substantial clinical challenges due to their deep anatomical location and proximity to vital neurovascular structures. Limited awareness and diagnostic delays remain major obstacles to early detection of paediatric brain tumours. For the last two decades, the 5-year overall and event-free survival of children with posterior fossa tumours has been doubled due to the improvement in the diagnostic tools and the advances in the surgical techniques approaching total or near-total resection. MATERIALS AND METHODS: This retrospective comparative cohort study was conducted at a tertiary care cancer hospital in Pakistan, following approval from the Institutional Review Board (IRB). The study included paediatric patients with posterior fossa tumours treated between January 2021 and February 2025 and compared two cohorts: the Regular Pathway and the Rapid Assessment Pathway (RAPT). Collected variables included demographic characteristics, duration of symptoms, time interval from initial symptom onset to acceptance for treatment (from walk-in clinic), surgical intervention, frequency of shunt or external ventricular drain insertion and initiation of adjuvant therapy. Data were analysed using SPSS version 27. RESULTS: A total of 59 patients were included, 30 patients in the Regular Pathway (January 2021-December 2023) and 29 patients in RAPT (January 2024-February 25). In the Regular Pathway, the mean duration of acceptance after initial presentation was 15 days, as compared to RAPT, which was 5 days (p ≤ 0.001). The frequency of shunt insertion was reduced significantly in RAPT compared to Regular Pathways. A total of 83% of patients in RAPT were operated within 72 h of acceptance as compared to Regular Pathway cohorts, in which 55% patients had surgery within 4 weeks (p ≤ 0.001). The average duration of the start of adjuvant therapy in the RAPT cohort was within 6 weeks, while in the Regular Pathway cohort, it was 7 weeks. CONCLUSION: RapidRAPT has demonstrated a significant improvement in the timeliness of care for paediatric patients diagnosed with posterior fossa tumours. Early intervention facilitated by RAPT contributes to better outcomes and reduced treatment delays.