Multiple factors contribute to neuropsychological outcome in children with posterior fossa tumors.
ABSTRACT Cognitive deficits are frequently reported in children treated for posterior fossa (PF) tumors. A range of tumor, treatment, medical and treatment complications have been implicated in causing a variety of cognitive deficits. The aim of this study is to identify factors that influence intelligence, attention and information processing in these children. Thirty-five children (aged 4-16) with PF tumors attending the Royal Children's Hospital Melbourne, Australia, were enrolled into a prospective, repeated measures design. Neuropsychological assessments were conducted at diagnosis and at 12 month intervals for three years. The results find that the PF tumor, hydrocephalus, white matter injury and radiation therapy have various impacts on intelligence, attention and information processing skills, and contribute to the long term outcome in children treated for PF tumor. The neurological structures that subserve the efficient function of attention and information processing are particularly vulnerable to those factors.
Article: Neurodevelopmental impact on children treated for medulloblastoma: a review and proposed conceptual model.[show abstract] [hide abstract]
ABSTRACT: The population of survivors following diagnosis and treatment for medulloblastoma is thankfully on the rise. An increased focus on the quality of that survivorship has expanded the concept of cure to include efforts aimed at improving long-term cognitive outcome. It is well established in the literature that decline in overall intellect and academic performance is experienced by a majority of those undergoing treatment for pediatric medulloblastoma. This decline is believed to be secondary to decline in core cognitive abilities, which in turn are related to underlying damage to neuroanatomical substrates. A review of research on neurodevelopmental impacts following diagnosis and treatment for pediatric medulloblastoma is presented. Particular consideration is given to studies recently published that also reflect critical collaboration among those within the fields of neuropsychology and neuro-imaging. Results from the review are combined within a conceptual model upon which to guide future research and clinical efforts.Developmental Disabilities Research Reviews 11/2008; 14(3):203-10. · 4.04 Impact Factor
Article: Long-term follow-up of children treated for high-grade gliomas: children's oncology group L991 final study report.[show abstract] [hide abstract]
ABSTRACT: High-grade gliomas of the CNS are characterized by poor treatment response and prognosis for long-term survival. The Children's Oncology Group (COG) L991 study investigated the neuropsychological, behavioral, and quality of life (QoL) outcomes after treatment on the Children's Cancer Group (CCG) trial for high-grade gliomas (CCG-945). Fifty-four patients (29 males, 25 females) with a median age of 8.8 years at diagnosis (range, 0.2 to 19.5 years) were enrolled at 25 institutions in North America, representing 81% of available survivors; median length of follow-up was 15.1 years (range, 9.5 to 19.2 years), and median age at study evaluation was 23.6 years (range, 11.3 to 36 years). Standardized tests of neuropsychological functioning and QoL were performed. Descriptive statistics summarized principal findings, and one-way analysis of variance identified potential predictors of outcomes. With an average follow-up time of 15 years, survivors demonstrated intellectual functioning within the low-average range. Executive functioning and verbal memory were between the low-average and borderline ranges. In contrast, visual memory and psychomotor processing speed were between the borderline and impaired ranges, respectively. Approximately 75% of patient reported overall QoL within or above normal limits for both physical and psychosocial domains. Nonhemispheric tumor location (midline or cerebellum), female sex, and younger age at treatment emerged as independent risk factors. These results serve as a benchmark for comparison with future pediatric high-grade glioma studies, in addition to identifying at-risk cohorts that warrant further research and proactive interventions to minimize late effects while striving to ensure survival.Journal of Clinical Oncology 02/2012; 30(9):943-9. · 18.37 Impact Factor