Older age is a protective factor for academic achievements irrespective of treatment modalities for posterior fossa brain tumours in children

Abstract

The treatment of children with posterior fossa brain tumours (PFBT) impacts their long term functional and imaging outcomes. This study aimed to evaluate academic achievement correlated with long-term sequelae after different PFBT treatment modalities. The study cohort consisted of 110 survivors (median age at diagnosis 10.1 years and median time of follow up 13.2 years) who completed hearing questionnaires, neurological assessment and MRI of the brain ≥5 years after the end of treatment. There were three treatment groups. A cisplatin group which underwent cisplatin chemotherapy, radiotherapy and surgery (medulloblastoma N = 40), a radiotherapy group which underwent radiotherapy and surgery (astrocytoma/ependymoma N = 30), and a surgery group (astrocytoma N = 40). Academic achievement was correlated to the age at diagnosis, ototoxicity, Karnofsky score (KS), and MRI findings (Fazekas Score (FS)- treatment related parenchymal changes). For a modelled age at diagnosis of five years, the cisplatin group had lower academic achievements compared to the radiotherapy (p = 0.028) and surgery (p = 0.014) groups. Academic achievements evaluated at a modelled age of 10 years at diagnosis did not significantly differ among the treatment groups. The cisplatin group exhibited a higher occurrence of ototoxicity than the radiotherapy (p<0.019) and surgery groups (p<0.001); however, there was no correlation between ototoxicity and academic achievements (p = 0.722) in older age at diagnosis. The radiotherapy group exhibited lower KS than the surgery group (p<0.001). KS significantly influenced academic achievements in all groups (p<0.000). The cisplatin group exhibited higher FS than the surgery group (p<0.001) while FS did not correlate with academic achievement (p = 0.399). Older age is a protective factor for academic achievements irrespective of a treatment modality.

Communication, academic and social outcomes of childhood cancer survivors with hearing loss: A systematic review

“…Across the remaining studies, 1342 out of 19,503 (6.9%) cancer patients had HL ranging from unilateral, bilateral and mild to profound. Most studies assessed hearing status using audiometric testing (15/23; 65.2%) 59–72 or parent/patient report (6/23; 26.1%) 57,58,73–76 …”

“…All except two studies (21/23; 91.3%) described cancer types 65,73 . Of these, 12/21 (57.1%) included participants with either central nervous system (CNS) or non‐CNS cancer types, 57,58,61,66,68–72,77–79 eight studies (8/21; 38.1%) included participants with only CNS cancer 59,60,62,64,67,74–76 and one (1/21; 4.8%) examined only non‐CNS cancer (soft tissue sarcoma) 63 …”

“…For 13/23 studies (56.5%), most participants were within the survivorship phase of cancer, 57–59,63,65,66,71,72,74,76–79 while 10/23 studies (43.5%) corresponded with the after‐hospital to outpatient phase 60–62,64,67–70,73,75 . No study included cancer inpatients.…”

“…found no significant differences in the level of education achieved by CCS with and without HL. 66,71,76 The fourth study (1/4; 25.0%) noted an indirect relationship: CCS were more likely to experience neurocognitive impairments, which were significantly associated with lower educational attainment. 77 Six studies examined the self-or parent-perceived school functioning of CCS with treatment-induced HL.…”

“…Four studies compared the level of education achieved between CCS with and without HL. 66,71,76,77 Of these, three studies (3/4; 75.0%)…”