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Neurocognitive development of children after a cerebellar tumor in infancy: A longitudinal study
D R Copeland1, C deMoor, B D Moore
1University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA. dcopelan@mdanderson.org
Insights
Children with cerebellar tumors diagnosed in infancy generally have positive neurocognitive outcomes, especially with surgery and chemotherapy. However, cranial radiation therapy (CRT) may lead to long-term deficits.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Developmental Pediatrics
Background:
- Infancy diagnosis of cerebellar tumors presents unique challenges for long-term neurodevelopmental assessment.
- Understanding the sequelae of early-life brain tumors is crucial for effective intervention.
Purpose of the Study:
- To evaluate the long-term neuropsychological effects in children diagnosed with cerebellar tumors during infancy.
- To identify factors influencing neurocognitive outcomes, including treatment modalities.
Main Methods:
- Prospective assessment of 27 children with posterior fossa tumors diagnosed before 36 months of age.
- Utilized comprehensive, age-appropriate neuropsychological tests at diagnosis and follow-up.
- Employed mixed-model regression to analyze cognitive developmental growth curves, controlling for covariates.
Main Results:
- Most patients demonstrated scores within normal limits at follow-up, with minimal decline over time.
- Children treated with cranial radiation therapy (CRT) showed significantly lower verbal IQ and motor skills compared to non-irradiated peers.
- Growth curve analysis revealed significant differences between CRT and non-CRT groups in verbal IQ, performance IQ, perceptual-motor, language, and attention/executive skills.
Conclusions:
- Cerebellar tumors diagnosed in infancy have a generally positive neurocognitive outlook with surgery and chemotherapy alone.
- Cranial radiation therapy (CRT) is associated with significant long-term neurocognitive and psychosocial deficits requiring intervention.
- Early intervention and tailored support are essential for children undergoing CRT for cerebellar tumors.
Purpose:
To assess the long-term neuropsychologic effects experienced by children who have tumors in the cerebellum that are diagnosed and treated during infancy.
Patients And Methods:
Twenty-seven children with posterior fossa tumors diagnosed at less than 36 months of age were assessed prospectively with a comprehensive set of age-appropriate tests. Group means and SDs are reported for assessments conducted at diagnosis (analysis 1) and at the most recent follow-up appointment (analysis 2). Cognitive developmental growth curves were derived from the prospective data (analysis 3) using mixed model regression analyses and controlling for age at diagnosis and socioeconomic status.
Results:
In the first analysis, eight of 11 infants at diagnosis scored within normal limits on all neuropsychologic domains, except for motor skills, which were impaired. In the second analysis, mean scores at the most recent follow-up of 21 of 27 patients were mostly in the normal range; however, group comparisons between those who had (n = 7) and had not (n = 14) been treated with cranial radiation therapy (CRT) showed that patients in the irradiated (CRT) group scored significantly lower than those in the nonirradiated (No-CRT) group on verbal intelligence quotient (IQ) and in the motor domain. In the third analysis (growth curves of CRT and No-CRT groups), statistically significant differences in slope were found on verbal IQ, performance IQ, perceptual-motor skills, language, and attention/executive skills. Slopes on the fine-motor domain were similar; both groups declined at approximately the same rate.
Conclusion:
Neurocognitive development and outcome of children with cerebellar tumors diagnosed in infancy is very positive among those who were treated with surgery and chemotherapy. Declines in performance across time were minimal, and scores tended to remain within normal limits. By itself, a cerebellar tumor in infancy does not seem to have a significant impact on children. However, those who received CRT as part of their treatment are likely to have neurocognitive and psychosocial deficits that require remediational interventions.