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Survival and long-term health and cognitive outcomes after low-grade glioma
Gregory T Armstrong1, Heather M Conklin, Sujuan Huang
1Department of Epidemiology & Cancer Control, St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 735, Memphis, TN 38105, USA. greg.armstrong@stjude.org
Insights
Children with low-grade glioma (LGG) face significant long-term health issues, including vision and hearing loss, hormonal deficiencies, and cognitive impairment, which increase over time. Radiation therapy and tumor location are key risk factors for these adverse effects in childhood LGG survivors.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Long-term Outcomes Research
Background:
- Childhood low-grade glioma (LGG) survivors experience significant long-term morbidity.
- Characterizing exposure-specific late effects is crucial for improving quality of life.
- Understanding risk factors for adverse health outcomes is essential for targeted interventions.
Purpose of the Study:
- To characterize the long-term morbidity and survival outcomes for children diagnosed with LGG.
- To identify risk factors associated with the development of late adverse health effects.
- To evaluate the cumulative incidence of specific late effects 15 years post-diagnosis.
Main Methods:
- Retrospective analysis of 361 children diagnosed with LGG between 1985 and 2007.
- Estimation of overall survival (OS) and progression-free survival (PFS).
- Risk factor identification using Fine and Gray's proportional hazards model, accounting for competing risks.
Main Results:
- 15-year OS was 86% and PFS was 55%.
- Among 5-year survivors, cumulative incidence of adverse outcomes at 15 years included blindness (18%), hearing loss (22%), obesity (53%), and hormonal deficiencies (up to 33%).
- Radiation therapy and diencephalic tumor location were significant independent predictors of multiple late effects; 34% of survivors had below-average IQ.
Conclusions:
- Childhood LGG survivors face substantial and progressive long-term adverse effects.
- Radiation therapy and tumor location are critical risk factors for specific late morbidities.
- Long-term surveillance and management strategies are necessary to address the increasing burden of late effects.
Abstract:
Long-term morbidity for children with low-grade glioma (LGG) requires exposure-specific characterization. Overall survival (OS) and progression-free survival (PFS) were estimated for 361 children diagnosed with LGG between 1985 and 2007 at a single institution. Five-year survivors (n = 240) received risk-based clinical assessment. Cumulative incidence of late effects 15 years from diagnosis were estimated. Risk factors for adverse health were identified using Fine and Gray's approach to Cox's proportional hazards model, accounting for death as a competing risk. OS at 15 years was 86% (95% confidence interval [CI] 82%-90%), and PFS was 55% (95% CI 51%-58%). Among the 240 5-year survivors, the 5-, 10-, and 15-year cumulative incidence of adverse outcomes included blindness: 10%, 13%, and 18%, respectively; hearing loss: 8%, 14%, and 22%; obesity/overweight: 18%, 35%, and 53%; hyperinsulinism: 1%, 5%, and 24%; growth hormone deficiency: 13%, 27%, and 29%;thyroid hormone deficiency: 16%, 28%, and 33%; and adrenocorticotropic hormone (ACTH) deficiency: 12%, 22%, and 26%. Multivariable models demonstrated radiation therapy to be a significant independent predictor of hearing loss, growth hormone deficiency, abnormal thyroid function, and ACTH deficiency. Diencephalic location was a statistically significant independent risk factor for blindness, growth hormone deficiency, abnormal thyroid function, and ACTH deficiency. Among the 182 5-year survivors assessed for intellectual function, 34% had an intelligence quotient (IQ) below average (<85), associated with younger age at diagnosis, epilepsy, and shunt placement. Survivors of childhood LGG experience substantial long-term adverse effects that continue to increase well beyond the 5-year survival time point.
