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Functional and neuropsychological late outcomes in posterior fossa tumors in children
Alvaro Lassaletta1, Eric Bouffet1, Donald Mabbott2
1Division of Pediatric Neuro-oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Insights
Childhood posterior fossa tumors can cause long-term neurodevelopmental issues. New interventions are needed to improve survivors' quality of life and minimize neurotoxicity.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Childhood Cancer Survivorship
Background:
- Posterior fossa (PF) tumors are the most common type of childhood intracranial tumors, accounting for up to 60% of cases.
- While survival rates have improved, the quality of survival is a critical outcome measure for affected children.
- Damage from tumors, hydrocephalus, and treatments can lead to significant long-term physical and neuropsychological sequelae.
Purpose of the Study:
- To review the long-term outcomes and quality of life for survivors of childhood posterior fossa tumors.
- To identify current interventions aimed at improving neuropsychological functioning in these survivors.
- To highlight the need for novel therapeutic strategies to mitigate treatment-related neurotoxicity.
Main Methods:
- Review of existing literature on childhood posterior fossa tumors, focusing on long-term sequelae and quality of life.
- Analysis of current intervention strategies, including pharmacological, cognitive remediation, and computerized cognitive training.
- Identification of gaps in current research and therapeutic approaches.
Main Results:
- Survivors often experience deficits in physical functioning, academic performance, memory, attention, speech, and executive functions.
- Endocrinological complications and secondary tumors can further impact long-term quality of life.
- Many survivors require special education services and face reduced high school graduation and employment rates.
Conclusions:
- Improving the quality of life for childhood posterior fossa tumor survivors requires addressing long-term neurodevelopmental and physical sequelae.
- Current interventions show promise but are insufficient to fully ameliorate neurotoxic effects.
- Development of new strategies to prevent and treat neurotoxicity is essential for optimizing outcomes in pediatric cancer survivors.
Abstract:
Tumors of the posterior fossa (PF) account for up to 60 % of all childhood intracranial tumors. Over the last decades, the mortality rate of children with posterior fossa tumors has gradually decreased. While survival has been the primary objective in most reports, quality of survival increasingly appears to be an important indicator of a successful outcome. Children with a PF tumor can sustain damage to the cerebellum and other brain structures from the tumor itself, concomitant hydrocephalus, the consequences of treatment (surgery, chemotherapy, radiotherapy), or a combination of these factors. Together, these contribute to long-term sequelae in physical functioning, neuropsychological late outcomes (including academic outcome, working memory, perception and estimation of time, and selective attention, long-term neuromotor speech deficits, and executive functioning). Long-term quality of life can also be affected by endocrinological complication or the occurrence of secondary tumors. A significant proportion of survivors of PF tumors require long-term special education services and have reduced rates of high school graduation and employment. Interventions to improve neuropsychological functioning in childhood PF tumor survivors include (1) pharmacological interventions (such as methylphenidate, modafinil, or donepezil), (2) cognitive remediation, and (3) home-based computerized cognitive training. In order to achieve the best possible outcome for survivors, and ultimately minimize long-term complications, new interventions must be developed to prevent and ameliorate the neuro-toxic effects experienced by these children.
