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Journal of Neuro-Oncology

, Volume 133, Issue 1, pp 119–128 | Cite as

Long-term neuropsychological follow-up of young children with medulloblastoma treated with sequential high-dose chemotherapy and irradiation sparing approach

  • Taryn B. Fay-McClymont
  • Danielle M. Ploetz
  • Don Mabbott
  • Karin Walsh
  • Amy Smith
  • Susan N. Chi
  • Elizabeth Wells
  • Jennifer Madden
  • Ashley Margol
  • Jonathan Finlay
  • Mark W. Kieran
  • Douglas Strother
  • Girish Dhall
  • Roger J. Packer
  • Nicholas K. Foreman
  • E. Bouffet
  • Lucie Lafay-CousinEmail author
Clinical Study

Abstract

High-dose chemotherapy (HDC) strategies were developed in brain tumor protocols for young children to prevent neuropsychological (NP) impairments associated with radiotherapy. However, comprehensive NP evaluations of these children treated with such strategies remain limited. We examined the long-term neurocognitive outcomes of young children (<6 years) with medulloblastoma, treated similarly, with a HDC strategy “according to” the chemotherapy regimen of the protocol CCG 99703. This retrospective study included young children less than 6 years of age at diagnosis of medulloblastoma treated from 1998 to 2011 at 7 North American institutions. Twenty-four patients who had at least one NP assessment post-treatment are the focus of the current study. Of 24 patients in this review, 15 (63%) were male and the mean age at diagnosis was 29.4 months (SD = 13.5). Posterior fossa syndrome (PFs) was reported in five patients (21%). Nine (37.5%) received radiotherapy (5 focal, 4 craniospinal). On average, children were assessed 3.5 years (SD = 1.8) post-diagnosis, and full-scale intellectual quotient (FSIQ) scores ranged from 56 to 119 (\({\bar{\text{X}}}\)= 92; SD = 16.8). The majority of children (74%) had low-average to average NP functioning. Very young children treated with radiotherapy, who needed hearing support or with PFs had worse neurocognitive outcomes. Clinically significant deficits (<10th percentile) in at least one area of NP functioning were found in 25% of the children. NP data obtained from this sample of survivors of medulloblastoma in early childhood, all treated with sequential HDC and 1/3 with radiotherapy, describe NP functioning within average normal limits overall. However, almost 25% of children had significant deficits in specific domains.

Keywords

Neurocognitive outcome Young children Medulloblastoma Radiation avoidance High-dose chemotherapy 

Supplementary material

11060_2017_2409_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 19 KB)

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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Taryn B. Fay-McClymont
    • 1
  • Danielle M. Ploetz
    • 2
  • Don Mabbott
    • 3
  • Karin Walsh
    • 4
  • Amy Smith
    • 5
  • Susan N. Chi
    • 6
  • Elizabeth Wells
    • 7
  • Jennifer Madden
    • 8
  • Ashley Margol
    • 9
  • Jonathan Finlay
    • 10
  • Mark W. Kieran
    • 6
  • Douglas Strother
    • 1
  • Girish Dhall
    • 9
  • Roger J. Packer
    • 11
  • Nicholas K. Foreman
    • 12
  • E. Bouffet
    • 3
  • Lucie Lafay-Cousin
    • 1
    Email author
  1. 1.Division of Pediatric Hematology Oncology and Bone Marrow TransplantationAlberta Children’s HospitalCalgaryCanada
  2. 2.Department of NeuropsychologyKennedy Krieger InstituteBaltimoreUSA
  3. 3.Division of Pediatric Hematology OncologyHospital for Sick ChildrenTorontoCanada
  4. 4.Department of NeuropsychologyChildren’s National Medical CenterWashingtonUSA
  5. 5.Arnold Palmer HospitalOrlandoUSA
  6. 6.Pediatric Neuro-OncologyDana-Farber Cancer InstituteBostonUSA
  7. 7.Pediatrics, Neurology and Integrative Systems Biology Brain Tumor InstituteChildren’s National Health SystemWashingtonUSA
  8. 8.CPNP, Children’s Hospital ColoradoUniversity of ColoradoAuroraUSA
  9. 9.Children’s Hospital Los AngelesKeck School of Medicine of University of Southern CaliforniaLos AngelesUSA
  10. 10.Nationwide Children’s Hospital and The Ohio State UniversityColumbusUSA
  11. 11.Center for Neuroscience and Behavioral MedicineBrain Tumor Institute Children’s National Health SystemWashingtonUSA
  12. 12.University of ColoradoAuroraUSA

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