TY - JOUR
T1 - Intellectual and functional outcome of children 3 years old or younger who have CNS malignancies
AU - Fouladi, Maryam
AU - Gilger, Elizabeth
AU - Kocak, Mehmet
AU - Wallace, Dana
AU - Buchanan, Gray
AU - Reeves, Cara
AU - Robbins, Nicole
AU - Merchant, Thomas
AU - Kun, Larry E.
AU - Khan, Raja
AU - Gajjar, Amar
AU - Mulhern, Raymond
PY - 2005
Y1 - 2005
N2 - Purpose: To evaluate the impact of tumor location, clinical parameters, and therapy on neurocognitive, neuroendocrine, and functional outcomes in children ≤ 3 years old with intracranial CNS malignancies who survived at least 2 years after diagnosis. Patients and Methods: Records were retrospectively reviewed for 194 children diagnosed from 1985 to 1999 at St Jude Children's Research Hospital (Memphis, TN). Results: The median age at diagnosis was 1.8 years (range, 0.1 to 3.5 years). Median follow-up was 7.64 years (2.0 to 19.4 years). Tumors were infratentorial (102), diencephalic (53), and hemispheric (39); 47% required ventriculoperitoneal shunts, 36% developed seizure disorders, and 20% developed severe ototoxicity. Therapy included no radiation therapy (RT) in 57 (30%), local RT in 87 (45%), and craniospinal irradiation (CSI) in 49 (25%). Overall survival at 10 years was 78 ± 4%. In a longitudinal analysis of 126 patients with at least one neurocognitive evaluation (NE), the mean rate of intelligence quotient (IQ) change for patients who received CSI (-1.34 points per year) and local RT (-0.51 points per year) was significantly different from the no RT group (0.91 points per year; P = .005 and P = .036, respectively). Patients with hemispheric tumors had a significantly greater IQ decline (-1.52 points per year) than those with midline tumors (0.59 points per year; P = .038). Among those with NE ≥ 5 years after diagnosis, 71.4% of CSI recipients compared with 23% of local RT recipients had IQ less than 70 (P = .021). Patients undergoing CSI were more likely to develop endocrinopathies (P < .0001) and to require special education (P = .0007). Conclusion: In young children with CNS tumors, CSI and hemispheric location are associated with significant declines in IQ scores.
AB - Purpose: To evaluate the impact of tumor location, clinical parameters, and therapy on neurocognitive, neuroendocrine, and functional outcomes in children ≤ 3 years old with intracranial CNS malignancies who survived at least 2 years after diagnosis. Patients and Methods: Records were retrospectively reviewed for 194 children diagnosed from 1985 to 1999 at St Jude Children's Research Hospital (Memphis, TN). Results: The median age at diagnosis was 1.8 years (range, 0.1 to 3.5 years). Median follow-up was 7.64 years (2.0 to 19.4 years). Tumors were infratentorial (102), diencephalic (53), and hemispheric (39); 47% required ventriculoperitoneal shunts, 36% developed seizure disorders, and 20% developed severe ototoxicity. Therapy included no radiation therapy (RT) in 57 (30%), local RT in 87 (45%), and craniospinal irradiation (CSI) in 49 (25%). Overall survival at 10 years was 78 ± 4%. In a longitudinal analysis of 126 patients with at least one neurocognitive evaluation (NE), the mean rate of intelligence quotient (IQ) change for patients who received CSI (-1.34 points per year) and local RT (-0.51 points per year) was significantly different from the no RT group (0.91 points per year; P = .005 and P = .036, respectively). Patients with hemispheric tumors had a significantly greater IQ decline (-1.52 points per year) than those with midline tumors (0.59 points per year; P = .038). Among those with NE ≥ 5 years after diagnosis, 71.4% of CSI recipients compared with 23% of local RT recipients had IQ less than 70 (P = .021). Patients undergoing CSI were more likely to develop endocrinopathies (P < .0001) and to require special education (P = .0007). Conclusion: In young children with CNS tumors, CSI and hemispheric location are associated with significant declines in IQ scores.
UR - http://www.scopus.com/inward/record.url?scp=27244443906&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=27244443906&partnerID=8YFLogxK
U2 - 10.1200/JCO.2005.01.214
DO - 10.1200/JCO.2005.01.214
M3 - Review article
C2 - 16192599
AN - SCOPUS:27244443906
SN - 0732-183X
VL - 23
SP - 7152
EP - 7160
JO - Journal of Clinical Oncology
JF - Journal of Clinical Oncology
IS - 28
ER -