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Neuro Oncol. 2017 May 1;19(5):689-698. doi: 10.1093/neuonc/now242.

Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: a report from the Childhood Cancer Survivor Study.

Author information

1
Washington University School of Medicine, Siteman Cancer Center, St. Louis Children's Hospital, and Barnes Jewish Hospital, St. Louis, Missouri, USA.
2
Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
3
St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
4
Memorial Sloan Kettering Cancer Center, New York, NY, USA.
5
Mattel Children's Hospital at the University of California Los Angeles, Los Angeles,California, USA.
6
Children's National Health System, Washington, DC, USA.
7
The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
8
Boston Children's Hospital, Boston, Massachusetts, USA.

Abstract

Background:

Medulloblastoma is the most common malignant childhood brain tumor, although long-term risks for chronic neurologic health and psychosocial functioning in aging adult survivors are incompletely characterized.

Methods:

The Childhood Cancer Survivor Study (CCSS) includes 380 five-year survivors of medulloblastoma/primitive neuroectodermal tumor (PNET; median age at follow-up: 30 y, interquartile range 24-36) and sibling comparison (n = 4031). Cumulative incidence of neurologic health conditions was reported. Cox regression models provided hazard ratios (HRs) and 95% CIs. Cross-sectional outcomes were assessed using generalized linear models.

Results:

Compared with siblings, survivors were at increased risk of late-onset hearing loss (HR: 36.0, 95% CI: 23.6-54.9), stroke (HR: 33.9, 95% CI: 17.8-64.7), seizure (HR: 12.8, 95% CI: 9.0-18.1), poor balance (HR: 10.4, 95% CI: 6.7-15.9), tinnitus (HR: 4.8, 95% CI: 3.5-6.8), and cataracts (HR: 31.8, 95% CI: 16.7-60.5). Temporal/frontal lobe radiotherapy of 50 Gy or more increased risk for hearing loss (HR: 1.9, 95% CI: 1.1-1.3), seizure (HR: 2.1, 95% CI: 1.1-3.9), stroke (HR: 3.5, 95% CI: 1.3-9.1), and tinnitus (HR: 2.0, 95% CI: 1.0-3.9). Survivors were less likely than siblings to earn a college degree (relative risk [RR]: 0.49, 95% CI: 0.39-0.60), marry (RR: 0.35, 95% CI: 0.29-0.42), and live independently (RR: 0.58, 95% CI: 0.52-0.66).

Conclusions:

Adult survivors of childhood medulloblastoma/PNET demonstrate pronounced risk for hearing impairment, stroke, lower educational attainment, and social independence. Interventions to support survivors should be a high priority.

KEYWORDS:

late effects; medulloblastoma; neurologic outcomes; psychosocial outcomes

PMID:
28039368
PMCID:
PMC5464442
DOI:
10.1093/neuonc/now242
[Indexed for MEDLINE]
Free PMC Article

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