Long-term neuropsychological follow-up of young children with medulloblastoma treated with sequential high-dose chemotherapy and irradiation sparing approach

Abstract

High-dose chemotherapy (HDC) strategies were developed in brain tumor protocols for young children to prevent neuropsychological (NP) impairments associated with radiotherapy. However, comprehensive NP evaluations of these children treated with such strategies remain limited. We examined the long-term neurocognitive outcomes of young children (<6 years) with medulloblastoma, treated similarly, with a HDC strategy "according to" the chemotherapy regimen of the protocol CCG 99703. This retrospective study included young children less than 6 years of age at diagnosis of medulloblastoma treated from 1998 to 2011 at 7 North American institutions. Twenty-four patients who had at least one NP assessment post-treatment are the focus of the current study. Of 24 patients in this review, 15 (63%) were male and the mean age at diagnosis was 29.4 months (SD = 13.5). Posterior fossa syndrome (PFs) was reported in five patients (21%). Nine (37.5%) received radiotherapy (5 focal, 4 craniospinal). On average, children were assessed 3.5 years (SD = 1.8) post-diagnosis, and full-scale intellectual quotient (FSIQ) scores ranged from 56 to 119 ([Formula: see text]= 92; SD = 16.8). The majority of children (74%) had low-average to average NP functioning. Very young children treated with radiotherapy, who needed hearing support or with PFs had worse neurocognitive outcomes. Clinically significant deficits (<10th percentile) in at least one area of NP functioning were found in 25% of the children. NP data obtained from this sample of survivors of medulloblastoma in early childhood, all treated with sequential HDC and 1/3 with radiotherapy, describe NP functioning within average normal limits overall. However, almost 25% of children had significant deficits in specific domains.

HDL nanoparticles targeting sonic hedgehog subtype medulloblastoma

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“…Only three of our described survivors received radiation (2 focal and 1 CSI). We've analyzed a similar cohort of 24 young children with medulloblastoma (median age at diagnosis of 29 months) treated with maximal safe surgery, sequential high dose chemotherapy using same chemotherapy agents (as per the protocol CCG 99703) and a similar rate of radiation use and found a relatively preserved neurocognitive profile with a mean FSIQ of 91.6 (SD = 16.8) . Thus, with nearly identical therapy, differences in NP function overall may lead us to explore specific characteristics of patients with ATRT that could contribute to worse neurocognitive outcome such as the impact of the supratentorial location, the frequency of associated hydrocephalus, or the potential impact of intrathecal chemotherapy.…”

Children treated for medulloblastoma and supratentorial primitive neuroectodermal tumor in Norway from 1974 through 2013: Unexplainable regional differences in survival

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