Long-term neuropsychological outcomes of survivors of young childhood brain tumors treated on the Head Start II protocol

Author:

Levitch Cara F1,Malkin Benjamin1,Latella Lauren2,Guerry Whitney3,Gardner Sharon L4,Finlay Jonathan L5,Sands Stephen A1

Affiliation:

1. Department of Psychiatry and Behavioral Sciences and Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York, USA

2. Graduate School of Education, Fordham University, Bronx, New York, USA

3. Department of Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA

4. Department of Pediatrics, NYU Langone Health, New York, New York, USA

5. Department of Pediatrics and Division of Hematology, Oncology, and Blood & Marrow Transplantation, Nationwide Children’s Hospital and The Ohio State University, Columbus, Ohio, USA

Abstract

Abstract Background The Head Start treatment protocols have focused on curing young children with brain tumors while avoiding or delaying radiotherapy through using a combination of high-dose, marrow-ablative chemotherapy and autologous hematopoietic cell transplantation (AuHCT). Late effects data from treatment on the Head Start II (HS II) protocol have previously been published for short-term follow-up (STF) at a mean of 39.7 months post-diagnosis. The current study examines long-term follow-up (LTF) outcomes from the same cohort. Methods Eighteen HS II patients diagnosed with malignant brain tumors <10 years of age at diagnosis completed a neurocognitive battery and parents completed psychological questionnaires at a mean of 104.7 months’ post-diagnosis. Results There was no significant change in Full Scale IQ at LTF compared to baseline or STF. Similarly, most domains had no significant change from STF, including verbal IQ, performance IQ, academics, receptive language, learning/memory, visual-motor integration, and externalizing behaviors. Internalizing behaviors increased slightly at LTF. Clinically, most domains were within the average range, except for low average mathematics and receptive language. Additionally, performance did not significantly differ by age at diagnosis or time since diagnosis. Of note, children treated with high-dose methotrexate for disseminated disease or atypical teratoid/rhabdoid tumor displayed worse neurocognitive outcomes. Conclusions These results extend prior findings of relative stability in intellectual functioning for a LTF period. Ultimately, this study supports that treatment strategies for avoiding or delaying radiotherapy using high-dose, marrow-ablative chemotherapy and AuHCT may decrease the risk of neurocognitive and social-emotional declines in young pediatric brain tumor survivors.

Funder

Making Headway Foundation

Publisher

Oxford University Press (OUP)

Subject

Medicine (miscellaneous)

Reference52 articles.

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