Neurobehavioral and Neurologic Outcome in Long-Term Survivors of Posterior Fossa Brain Tumors: Role of Age and Perioperative Factors

Abstract

We evaluated the neuropsychological and neurologic outcome of 15 long-term survivors of posterior fossa tumors who were treated between 1970 and 1984 with cranial irradiation (n = 15) and surgery (n = 14). The interval between diagnosis and evaluation ranged from 4 to 20 years (median = 10 years). Earlier age at diagnosis (< 6 years) was associated with an increased incidence of severe neurologic and neuropsychological sequelae. Hydrocephalus, obtundation, and tumor extension outside the vermis also were more prevalent in the younger group. Poor neurobehavioral outcomes in young children with posterior fossa tumors may be related to more aggressive tumor growth or complications of the initial therapy and not solely due to toxicity from craniospinal irradiation.

Pre‐radiation chemotherapy with response‐based radiation therapy in children with central nervous system germ cell tumors: A report from the Children's Oncology Group

“…While patients with germ cell tumors may present with permanent hormone deficiencies, brain and ventricular RT may cause neurocognitive impairment [47][48][49][50][51][52][53], as well as additional hormonal dysfunction. Neuraxis RT also causes growth retardation.…”

Identification of c-myc-dependent proteins in the medulloblastoma cell line D425Med

“…Treatment causes long-term morbidity including endocrine and growth disturbances, as well as neurocognitive dysfunction, which is particularly severe in young children (Chapman et al 1995;Dennis et al 1996;Radcliffe et al 1992;Silber et al 1992). Despite aggressive treatment, only 60% of children with MB will be cured ).…”

Neuropsychological sequelae of the treatment of children with medulloblastoma

“…In the Johnson et al [8] study, none of the 13 MB patients had an IQ over 90, and IQs were below normal both for children diagnosed under age 3 (Mean IQ = 65) and those diagnosed over age 3 (Mean IQ = 80). Accordingly, 6-7 [4,28] and 8 [13] have also been identified as ages below which MB diagnosis is associated with intellectual deficit.…”

“…Tumor surgery may also be more complex in younger children, and the extent of tumor resection is important in decisions about adjuvant therapy. Peri-operative complications, associated in some samples with lowered IQ [10], are more prevalent in younger children and are correlated with poorer neuropsychological outcome [28]. The interactive effects of the various tumorrelated variables on neuropsychological function (rather than on survival) remain to be fully understood.…”