Exploring Long-Term Neurocognitive Impact of Pineal Region Tumors: Clinical and Therapeutical Perspectives from a Single-Center Study

<i>Purpose:</i> Pineal region tumors are rare tumors in the pediatric population, typically managed with surgical resection or biopsy, and often with radiation therapy and chemotherapy. This study aims to examine the clinical and neurocognitive outcomes of pediatric patients with pineal tumors. <i>Methods:</i> A retrospective analysis was conducted on pediatric patients with pineal region tumors treated at Istituto Giannina Gaslini, Genoa, from January 1998 to July 2023. Data on medical history, surgical approaches, histological findings, administered therapies, long-term outcomes using the Glasgow Outcome Scale (GOS), education level, and employment status were collected. Statistical analysis was performed using SPSS software. <i>Results:</i> We identified 38 patients, with germinoma being the most prevalent tumor (47.4%). Surgical interventions included endoscopic biopsy (20 patients), stereotactic biopsy (5 patients), and excisional surgery (5 patients). Thirty-three patients received chemotherapy, and 35 underwent adjuvant radiotherapy. The mean follow-up duration was 8.79 ± 5.71 years. Significant correlations were found between tumor dissemination at diagnosis and patient outcomes (<i>p</i>-value = 0.03). Notably, patients in GOS classes 5-6 did not significantly differ from those in classes 7-8 regarding the frequency of intervention. School dropout rates significantly differed between GOS classes 5-6 and 7-8. <i>Conclusions:</i> This study highlights that prognosis is strongly associated with tumor aggressiveness, and particularly dissemination at diagnosis. The findings also suggest potential cognitive impairments, possibly linked to melatonin dysfunction induced by tumor-related treatments, as indicated by school dropout and employment data. <i>Implications for Cancer Survivors</i>: Our results underscore the need for further investigation into the impact of pineal involvement and potential therapeutic strategies.