Cognitive and adaptive outcome in low-grade pediatric cerebellar astrocytomas: Evidence of diminished cognitive and adaptive functioning in national collaborative research studies (CCG 9891/POG 9130)
Cognitive and adaptive outcome in low-grade pediatric cerebellar astrocytomas: Evidence of diminished cognitive and adaptive functioning in national collaborative research studies (CCG 9891/POG 9130)
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DOI：
10.1200/jco.2005.06.117
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发表时间：
2005-08-01
影响因子：
45.3
通讯作者：
Wisoff, JH
中科院分区：
文献类型：
--
作者：
Beebe, DW;Ris, MD;Wisoff, JH
临床医生通常认为，如果不接受颅照射，患有后颅窝肿瘤的儿童发生认知或适应性缺陷的风险很小。然而，小的病例系列已经对这一假设提出了质疑，并且还表明，未经照射的小脑肿瘤可以引起位置特异性认知和适应性障碍。本研究（1）评估了切除但未放疗的小儿小脑肿瘤是否与认知和适应功能缺陷相关，（2）检查了肿瘤位置和医疗并发症对认知和适应功能的影响。患者和方法样本由103名3至18岁的患有低级小脑星形细胞瘤的儿童组成，仅接受了儿童癌症组方案9891或儿科肿瘤组方案9130的手术治疗。根据原发肿瘤位置将样本分为三组：小脑蚓部、左半球或右半球。前瞻性地收集智力，学习成绩，适应能力，行为功能，和前，中，术后医疗complications.Results样本作为一个整体显示认知和适应性障碍的风险升高，是不一致的医疗并发症。在这组儿童小脑肿瘤，肿瘤的位置影响不大的认知，适应性，或医疗outcome.Conclusion我们没有复制以前的研究结果的位置特异性影响认知或适应性的结果。然而，这一人群中缺陷的风险升高与临床知识背道而驰，并建议临床医生应关注仅接受小脑肿瘤手术治疗的儿童的功能结局。
Purpose Clinicians often assume that children with posterior fossa tumors are at minimal risk for cognitive or adaptive deficits if they do not undergo cranial irradiation. However, small case series have called that assumption into question, and have also suggested that nonirradiated cerebellar tumors can cause location-specific cognitive and adaptive impairment. This study (1) assessed whether resected but not irradiated pediatric cerebellar tumors are associated with cognitive and adaptive functioning deficits, and (2) examined the effect of tumor location and medical complications on cognitive and adaptive functioning.Patients and Methods The sample was composed of 103 children aged 3 to 18 years with low-grade cerebellar astrocytomas, who underwent only surgical treatment as part of Children's Cancer Group protocol 9891 or Pediatric Oncology Group protocol 9130. The sample was divided into three groups based on primary tumor location: vermis, left hemisphere, or right hemisphere. Data were collected prospectively on intelligence, academic achievement, adaptive skills, behavioral functioning, and pre-, peri-, and postsurgical medical complications.Results The sample as a whole displayed an elevated risk for cognitive and adaptive impairment that was not associated consistently with medical complications. Within this group of children with cerebellar tumors, tumor location had little effect on cognitive, adaptive, or medical outcome.Conclusion We did not replicate previous findings of location-specific effects on cognitive or adaptive outcome. However, the elevated risk of deficits in this population runs contrary to clinical lore, and suggests that clinicians should attend to the functional outcomes of children who undergo only surgical treatment for cerebellar tumors.