Cognitive and adaptive outcome in extracerebellar low-grade brain tumors in children: a report from the Children's Oncology Group

Abstract

Purpose: To determine whether pediatric patients treated with surgery only for low-grade tumors in the cerebral hemispheres, supratentorial midline, and exophytic brainstem evidence neurocognitive, academic, adaptive, or emotional/behavioral sequelae.

Patients and methods: Ninety-three patients from a natural history study of low-grade astrocytomas were tested an average of 111 days after surgery. Rates of below average (< or = 25th percentile) scores in this sample were compared with test norms, and performances were compared across anatomic sites. Finally, the relationships of pre-, peri-, and postsurgical complications to outcome were investigated.

Results: For the entire sample, there was a significantly elevated rate of below average scores across intelligence quotient, achievement, and adaptive behavior, but not behavioral/emotional adjustment measures. Patients with hemispheric, midline, and brainstem tumors did not differ significantly. Patients with left hemisphere tumors generally performed worse than those with right hemisphere tumors. Finally, neurobehavioral outcome was unrelated to pre-, peri-, or postsurgery complications.

Conclusion: After surgery for low-grade brain tumors, a significant number of patients was found to function below average, by as much as 55% compared with 25% in the normative population. Moreover, these results suggest greater risk for patients with lesions situated in the left cerebral hemisphere. Routine neuropsychological follow-up of children after treatment for low-grade tumors is recommended.

Fig 1.

Percentage of scores below average (with 95% CI). VIQ, Verbal Intelligence Quotient; PIQ, Performance Intelligence Quotient; FSIQ, Full Scale Intelligence Quotient; WM, working memory; PS, psychomotor speed; VMI, Visual-Motor Integration; WRAT-R, Wide Range Achievement Test–Revised; Comm, Communication; DLS, Daily Living Skills; ABC, Adaptive Behavior Composite; Social, socialization; Internal, internalization; External, externalization.

Fig 2.

Means by tumor site (± 1 SE). VIQ, Verbal Intelligence Quotient; PIQ, Performance Intelligence Quotient; FSIQ, Full Scale Intelligence Quotient; Com_Vine, Vineland Communication; DLS_Vine, Vineland Daily Living Skills; ABC_Vine, Vineland Adaptive Behavior Composite.