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Randomized Controlled Trial
. 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

Allison A King  1 , Kristy Seidel  2 , Chongzhi Di  2 , Wendy M Leisenring  2 , Stephanie Mabry Perkins  1 , Kevin R Krull  3 , Charles A Sklar  4 , Daniel M Green  3 , Gregory T Armstrong  3 , Lonnie K Zeltzer  5 , Elizabeth Wells  6 , Marilyn Stovall  7 , Nicole J Ullrich  8 , Kevin C Oeffinger  4 , Leslie L Robison  3 , Roger J Packer  6
Affiliations
Randomized Controlled Trial

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

Allison A King et al. Neuro Oncol. .

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.

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Figures

Fig. 1
Fig. 1
Cumulative incidence of chronic health conditions among long-term survivors of medulloblastoma and PNET.
See this image and copyright information in PMC

References

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