TEMPORAL TRENDS AND REGIONAL DISTRIBUTION OF CHEMOTHERAPY TREATMENT RATES FOR MALIGNANT INTRACRANIAL NEOPLASMS IN CHILDREN AND ADOLESCENTS IN BRAZIL, 2016–2025: AN ECOLOGICAL STUDY

Abstract

Background: Central nervous system (CNS) neoplasms are the most common solid tumors in children and adolescents and the leading cause of cancer-related mortality in this age group in Brazil. Chemotherapy remains a cornerstone of treatment despite advances in targeted therapies and immunotherapy. Objective: To analyze the temporal trend and regional distribution of chemotherapy treatment rates for intracranial malignant neoplasms among children and adolescents aged 0–19 years in Brazil, from 2016 to 2025. Methods: This ecological time-series study used secondary data from the Oncology Panel of the Brazilian Unified Health System Informatics Department (DATASUS) on intracranial malignant neoplasms (ICD-10: C71), combined with population estimates from the Brazilian Institute of Geography and Statistics (IBGE). Annual and average treatment rates per 100,000 inhabitants were calculated for Brazil and its five macro-regions. Temporal trends were assessed using simple linear regression, and regional differences using one-way analysis of variance (ANOVA) with Tukey's post hoc test. Results: A total of 1,882 chemotherapy treatments were recorded between 2016 and 2025. A statistically significant increasing trend was observed nationally (β = 0.012; 95%CI: 0.0073–0.016; R² = 0.83; p < 0.001), with significant increases in the Northeast (β = 0.022; p < 0.001) and South (β = 0.032; p = 0.009) regions; the North, Southeast, and Midwest regions showed no significant temporal trend. The highest average rates were observed in the Midwest (0.503/100,000) and South (0.472/100,000), and the lowest in the North (0.208/100,000), with significant differences among macro-regions (F(4,45) = 18.21; p < 0.001; η² = 0.62). Conclusion: Chemotherapy treatment rates for pediatric intracranial malignant neoplasms showed an increasing trend in Brazil between 2016 and 2025, with heterogeneous evolution and distribution across macro-regions, suggesting potential structural inequalities in access to pediatric oncologic care.