QOL-13. NEUROCOGNITIVE OUTCOMES ACCORDING TO RISK-ADAPTED TREATMENT REGIMENS FOR CHILDREN OLDER THAN 4 WITH MEDULLOBLASTOMA AND POSTERIOR FOSSA EPENDYMOMA – RESULTS OF THE HIT2000 TRIAL
| Autor: | Andreas von Deimling, Martin Mynarek, Thomas Traunwieser, Rolf-Dieter Kortmann, David T.W. Jones, Monika Warmuth-Metz, Martin Sill, Felix Sahm, Tanja Tischler, Anne Neumann-Holbeck, Dominik Sturm, Brigitte Bison, Marcel Kool, Denise Obrecht, Holger Ottensmeier, Torsten Pietsch, Stefan Rutkowski, Anika Resch, Stefan M. Pfister, Katja von Hoff |
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| Rok vydání: | 2020 |
| Předmět: |
Ependymoma
Medulloblastoma Cancer Research Pediatrics medicine.medical_specialty business.industry medicine.medical_treatment Neuropsychology/Quality of Life medicine.disease Preoperative care Chemotherapy regimen Hydrocephalus Radiation therapy Oncology Quality of life medicine AcademicSubjects/MED00300 AcademicSubjects/MED00310 Neurology (clinical) business Neurocognitive |
| Zdroj: | Neuro-Oncology |
| ISSN: | 1523-5866 1522-8517 |
| DOI: | 10.1093/neuonc/noaa222.676 |
| Popis: | OBJECTIVES Reduced neuropsychological outcomes are a major concern in pediatric patients with malignant brain tumors. We aimed to estimate decline in cognitive function according to treatment regimens. METHODS Cross-sectional analysis of cognitive functions tested with the Neuropsychological Basic Diagnostic tool (NBD) in 279 patients >4 years at diagnosis (median: 8.66; range: 4.01–18.98) with medulloblastoma (n=110, 23.7–25.0Gy CSI; n=131, >30Gy CSI) or posterior fossa ependymoma (n=38 local radiotherapy) who participated in the HIT-2000 trial. Multivariable regression analysis was conducted to adjust for postoperative cerebellar mutism syndrome, preoperative hydrocephalus, postoperative shunt placement, the interval between diagnosis and assessment, sex and age. RESULTS Mean time from diagnosis to assessment was 5.1 years. Increasing CSI-dose was significantly associated with a deterioration in performance of most subtests, particularly in areas of fluid intelligence (mean z-values per test for no CSI/23.4Gy/>30Gy respectively: matrix reasoning:-0.40/-0.52/-0.98, p30Gy CSI, selective attention, but no other function was reduced in patients treated with pre-radiotherapy chemotherapy including intraventricular MTX (selective attention (with chemotherapy/without chemotherapy mean z-values: -0.66/0.00, p=.006)). Patients with SHH-activated medulloblastoma did significantly better than WNT or Group3/Group4 medulloblastoma patients in fluid intelligence and fine motor skills. CONCLUSION CSI dose among other highly relevant factors had significant effects on neuropsychological outcome. Pre-radiotherapy intraventricular MTX had only minor effects. Patients with SHH-activated medulloblastomas showed a more favorable outcome when compared to patients in the other subgroups. |
| Databáze: | OpenAIRE |
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