Cognitive Risk in Survivors of Pediatric Brain Tumors

Oyefiade, Adeoye; Paltin, Iris; Luca, Cinzia R De; Hardy, Kristina K.; Grosshans, David R.; Chintagumpala, Murali; Mabbott, Donald; Kahalley, Lisa S.

doi:10.1200/jco.20.02338

Cited by 44 publications

(60 citation statements)

References 71 publications

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“…Radiotherapy is usually avoided in infants due to the well-known detrimental impact on their subsequent psychomotor development [ 27 ]. Therefore, the poor prognosis is intricate with a higher incidence of early and late toxicities, experienced by long-term survivors [ 28 ]. Ali et al investigated 132 children with CSN tumors, identifying several factors as predictors of neurocognitive outcome such as lower baseline QI, supratentorial tumor location, and younger age at diagnosis; however, the authors did not report any negative impact of adjuvant treatment (chemotherapy and/or focal RT) [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Molecular Landscape in Infant High-Grade Gliomas: A Single Center Experience

et al. 2022

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High-grade gliomas (HGG) represent about 15% of all pediatric brain tumors, with a dismal prognosis and survival rates ranging from 15 to 35%. Approximately 10–12% of pediatric HGGs (pHGG) occur in children younger than five years of age at diagnosis, specifically infants (iHGG), with an unexpected overall survival rate (OS) in 60–70% of cases. In the literature, iHGGs include a large variety of heterogeneous lesions with different molecular profiles that likely explain their different outcomes. We report our single-institution experience of iHGG including 11 children under five years of age with newly diagnosed HGG between 2011 and 2021. All patients received surgery and adjuvant chemotherapy; only two patients received radiotherapy because their age at diagnosis was more than four years-old. Molecular investigations, including next generation sequencing (NGS) and DNA methylation, detected three NTRK-fusions, one ROS1-fusions, one MN1-rearrangement, and two PATZ1-fusions. According to the molecular results, when chemotherapy failed to control the disease, two patients benefited from target therapy with a NTRK-Inhibitor larotrectinib, achieving a complete remission and a very good partial response, respectively, and no severe side-effects. In conclusion, molecular investigations play a fundamental role in the diagnostic work-up and also in the therapeutic decision. Their routine use in clinical practice could help to replace highly toxic chemotherapy regimens with a target therapy that has moderate adverse effects, even in long-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Molecular Landscape in Infant High-Grade Gliomas: A Single Center Experience

et al. 2022

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“…A large body of literature documents neurocognitive late effects of pediatric brain tumors and treatment [ 2 , 17 ]. Late effects include tumor and treatment related cognitive changes that typically emerge in the first few years following treatment and may range from little or mild change to severe deficits that require the ongoing need for significant support into and through adulthood [ 2 ].…”

Section: Educational Pain Points For Pediatric Brain Tumor Survivorsmentioning

confidence: 99%

“…Tumor size [ 18 ], tumor location [ 19 ] and potential for complications, such as obstructive hydrocephalus affect neurocognitive outcomes independent of the treatment paradigm [ 20 ]. Younger age at diagnosis, longer time since treatment, genetic predispositions, chronic health conditions including ototoxicity, endocrinopathies, cardiac disease and other complications, such as epilepsy or stroke may increase the risk for, and the manifestation of neurocognitive late effects as time goes by [ 17 ].…”

Section: Educational Pain Points For Pediatric Brain Tumor Survivorsmentioning

confidence: 99%

Educational Pain Points for Pediatric Brain Tumor Survivors: Review of Risks and Remedies

et al. 2021

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Evolving treatment paradigms have led to increased survival rates for children diagnosed with a brain tumor, and this has increasingly shifted clinical and research focus to morbidity and quality of life among survivors. Among unfavorable outcomes, survivors of pediatric brain tumors are at risk for academic failure and low educational attainment, which may then contribute to lower health related quality of life, lower income and vocational status, and a greater likelihood of dependence on others in adulthood. Several specific risk factors for lower educational performance and attainment have been investigated. These are typically examined in isolation from one another which clouds understanding of the full range and potential interplay of contributors to educational difficulties. This review integrates and summarizes what is known about the direct and indirect barriers to educational success and performance (i.e., educational pain points) to enhance clinician knowledge of factors to consider when working with pediatric brain tumor survivors. Specific barriers to educational success include neurocognitive difficulties, school absences, psychosocial challenges, challenges to knowledge and communication, and physical and sensory difficulties. Finally, we discuss the current state of educational interventions and supports and offer recommendations for future research to improve educational outcomes for pediatric brain tumor survivors.

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“…However, much remains unknown with respect to predictors of social adjustment among survivors. Indeed, a recent review highlighted the identification of determinants of social impairment as one of the most important emerging areas in survivorship research 8 …”

Section: Introductionmentioning

confidence: 99%

Cognitive predictors of social adjustment in pediatric brain tumor survivors treated with photon versus proton radiation therapy

Warren

Raghubar

Cirino

et al. 2022

Pediatric Blood & Cancer

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Background Pediatric brain tumor survivors are at risk for poor social outcomes. It remains unknown whether cognitive sparing with proton radiotherapy (PRT) supports better social outcomes relative to photon radiotherapy (XRT). We hypothesized that survivors treated with PRT would outperform those treated with XRT on measures of cognitive and social outcomes. Further, we hypothesized that cognitive performance would predict survivor social outcomes. Procedure Survivors who underwent PRT (n = 38) or XRT (n = 20) participated in a neurocognitive evaluation >1 year post radiotherapy. Group differences in cognitive and social functioning were assessed using analysis of covariance (ANCOVA). Regression analyses examined predictors of peer relations and social skills. Results Age at evaluation, radiation dose, tumor diameter, and sex did not differ between groups (all p > .05). XRT participants were younger at diagnosis (XRT M = 5.0 years, PRT M = 7.6 years) and further out from radiotherapy (XRT M = 8.7 years, PRT M = 4.6 years). The XRT group performed worse than the PRT group on measures of processing speed (p = .01) and verbal memory (p < .01); however, social outcomes did not differ by radiation type. The proportion of survivors with impairment in peer relations and social skills exceeded expectation; χ2(1) = 38.67, p < .001; χ2(1) = 5.63, p < .05. Household poverty predicted peer relation difficulties (t = 2.18, p < .05), and verbal memory approached significance (t = −1.99, p = .05). Tumor diameter predicted social skills (t = −2.07, p < .05). Conclusions Regardless of radiation modality, survivors are at risk for social challenges. Deficits in verbal memory may place survivors at particular risk. Results support monitoring of cognitive and social functioning throughout survivorship, as well as consideration of sociodemographic risk factors.

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Cognitive Risk in Survivors of Pediatric Brain Tumors

Cited by 44 publications

References 71 publications

Molecular Landscape in Infant High-Grade Gliomas: A Single Center Experience

Molecular Landscape in Infant High-Grade Gliomas: A Single Center Experience

Educational Pain Points for Pediatric Brain Tumor Survivors: Review of Risks and Remedies

Cognitive predictors of social adjustment in pediatric brain tumor survivors treated with photon versus proton radiation therapy

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