Tumor‐ and treatment‐related side effects after multimodal therapy of childhood intracranial germ cell tumors

Abstract

Multimodality treatment approaches have dramatically improved the outcome of patients with intracranial germ cell tumors and are resulting in an increasing number of long‐term survivors. The aim of the present study was to evaluate prospectively the development of side effects in children, adolescents and young adults after treatment for intracranial germ cell tumors. Nine patients with a median age of 14 y at diagnosis and a median follow‐up of 7.25 y underwent a detailed long‐term evaluation including physical and neuro‐ophthalmologic examinations, routine laboratory and endocrine stimulation tests, neuropsychometric testing, audiometry and spirometry at repeated intervals. Endocrine deficiencies requiring hormone replacement therapy occurred in all patients. Neuro‐ophthalmologic side effects were observed in 8 of the 9 patients, urinary electrolyte wasting in 4 of the 9, alopecia in 3 of the 9 and high‐frequency hearing loss in 2 of the 9. Neuropsychologic examinations revealed pathologic results in all five tested patients. Conclusion: The present study indicates that former intracranial germ cell tumor patients suffer from remarkable long‐term side effects, and that some of these late effects can develop or worsen months or years after cessation of oncologic therapy. Since life quality is an important parameter of cancer survival, careful follow‐up of long‐term survivors is mandatory, aimed at counteracting side effects as early as possible and therefore at minimizing long‐term morbidity, which may considerably compromise quality of life.

Longitudinal evaluation of neurocognitive function after treatment for central nervous system germ cell tumors in childhood

“…Previous reports have documented compromised perceptual reasoning, although location was not accounted for. 9, 11, 29 Our study provides a more detailed extension of these findings. Furthermore, patients with pineal tumors displayed early and stable deficits in working memory, information processing speed, and visual memory.…”

“…7, 9, 11, 28 Full‐scale and verbal intelligence remains relatively intact after treatment, but decreased speed of information processing and visual‐spatial intelligence is evident. 7, 9, 11, 26, 27, 29 Intact academic achievement and receptive vocabulary have also been documented. 7, 26 Younger patients show poorer intellectual outcomes than older patients.…”

Adult growth hormone replacement therapy and neuroimaging surveillance in brain tumour survivors

“…Our unit does believe in a role of AGHRT in brain tumour patients, who often suffer, like many other cancer patients, from long-term sequelae related to the tumour and its treatment. [28][29][30][31][32][33][34] These complications include endocrine deficiencies, 12,35 -42 obesity, 43 osteopenia, 44 cognitive dysfunction, 45 -47 emotional and behavioural disorders, 48 cerebrovascular accidents, 22 high-frequency…”

“…hearing loss, 34 and a poorer quality of life, 48,49 as well as anxiety about possible disease relapse and risk of second neoplasms. 13,15,24,50 -52 While many of those sequelae are irreversible, the benefits of hormonal replacement for endocrine deficiencies are indisputable.…”

Pineal Germ Cell Tumors: Review

“…sults and also the side effects in children, such as influence on growth, cognitive functions and neuroendocrine development [32][33][34], various authors concentrated on lowering the doses with the intention of reducing side effects [35,36]. Several studies draw the conclusion that craniospinal radiotherapy is not essential in localized germinomas [37].…”