Neurocognitive dysfunction in adult cerebellar medulloblastoma

Abstract

Objective Impaired neurocognitive function (NCF) is a well‐established consequence of pediatric medulloblastoma (MB) and its treatments. However, the frequency and features of neurocognitive dysfunction in adult‐onset MB patients are largely unknown. Methods Adult patients (≥ 18 years) with MB who had received formal neurocognitive evaluation (N = 27) were identified. Demographic, medical, and treatment histories were extracted from the medical record. Lesion properties on MRI were analyzed and used to evaluate lesion‐symptom mapping further. Demographically adjusted z‐scores were calculated for each neurocognitive test and used to assess impairment frequency. Regression analyses were conducted to identify clinical and paraclinical factors associated with impaired NCF. Results Mean age of the patient sample was 33 years (SD = 11) at the time of MB diagnosis. Prior therapy included surgical resection (89%), radiation (70%), and chemotherapy (26%). A significant proportion of patients were impaired on tests of verbal learning and memory (32%), executive function (29%), and naming (18%). Age, education, lesion size, time from surgery, and number of chemotherapy cycles had the greatest contribution to test performance in random‐forest regression models. Conclusion This study identifies frequent impairment of NCF in adult patients with MB, particularly in the domains of learning and memory and executive function. Neurocognitive impairment is influenced by patients' demographic, disease, and treatment history. Further study is warranted to characterize the clinical impact of adult MB more fully.

Clinical characterization of adult medulloblastoma and the effect of first-line therapies on outcome; The MD Anderson Cancer Center experience

“…Historically, these patients have been treated with high-or low-dose RT and first-line chemotherapy to minimize the risk of cognitive side effects of high-dose RT. 34 , 35 In this study, we determined the effect of RT dose on outcome in standard-risk patients; we did not detect a difference in patients who received < 30 Gy RT plus adjuvant chemotherapy and those who received ≥ 30 Gy RT alone.…”

Neurocognitive functioning and health-related quality of life in adult medulloblastoma patients: long-term outcomes of the NOA-07 study

“…The impact of treatment on neurocognition and HRQoL in adult medulloblastoma patients is understudied. A recent study reported impaired neurocognitive functioning (learning and memory, and executive function) shortly after diagnosis [13], while another study reported that adult medulloblastoma patients had problems with executive dysfunction, weakness, ataxia, depression or anxiety about nine years after radiotherapy [14]. These long-term sequelae may subsequently have a negative impact on HRQoL.…”

“…One of the most relevant long-term complications of radiotherapy in brain tumor patients is neurocognitive dysfunction [12], which may subsequently interfere with a patients' functioning in daily life, particularly role and social functioning. Although it has been shown that a large proportion of adult medulloblastoma patients have impaired neurocognitive functioning shortly after diagnosis, particularly in the domains learning, memory, and executive function [13], data on the short-and long-term impact of treatment on outcomes such as neurocognition and HRQoL are limited. One study reported impaired executive function, weakness, ataxia, depression and anxiety about nine years after radiotherapy [14].…”

The Alliance AMBUSH Trial: Rationale and Design

“…Few studies of adult MB survivors have been conducted. Harrison et al, conducted a cross-sectional study of 27 patients treated for MB during early adulthood in which 25–30% of patients displayed impaired executive function and new-learning performance that correlated with the amount of chemotherapy cycles received [ 39 ]. Dirven et al reported on 28 patients treated with radiation and chemotherapy.…”