Electroretinography and Visual Evoked Potentials in Childhood Brain Tumor Survivors

Abstract

This population-based cross-sectional study evaluates the clinical value of electroretinography and visual evoked potentials in childhood brain tumor survivors. A flash electroretinography and a checkerboard reversal pattern visual evoked potential (or alternatively a flash visual evoked potential) were done for 51 survivors (age 3.8-28.7 years) after a mean follow-up time of 7.6 (1.5-15.1) years. Abnormal electroretinography was obtained in 1 case, bilaterally delayed abnormal visual evoked potentials in 22/51 (43%) cases. Nine of 25 patients with infratentorial tumor location, and altogether 12 out of 31 (39%) patients who did not have tumors involving the visual pathways, had abnormal visual evoked potentials. Abnormal electroretinographies are rarely observed, but abnormal visual evoked potentials are common even without evident anatomic lesions in the visual pathway. Bilateral changes suggest a general and possibly multifactorial toxic/adverse effect on the visual pathway. Electroretinography and visual evoked potential may have clinical and scientific value while evaluating long-term effects of childhood brain tumors and tumor treatment.

Long-Term Follow-Up of Pediatric CNS Tumor Survivors—A Selection of Relevant Long-Term Issues

“…Potential Long-Term Issues pediatric CNS tumor adverse psychosocial/ quality of life effects mental health disorder [32] fatigue, sleep problems [33] neurological deficits due to tumor location chemotherapy and cranial radiotherapy dental abnormalities [34] alkylating agents (e.g., Cyclophosphamide, Ifosfamide) testicular hormonal dysfunction, impaired spermatogenesis [35] ovarian hormone deficiencies, reduced ovarian reserve [36] platinum agents (e.g., Carboplatin, Cisplatin) ototoxicity [37] nephrotoxicity [38] antimetabolites (e.g., Methotrexate) reduced bone mineral density [39] neurocognitive long-term issues, clinical leukencephalopathy [30,40] corticosteroids reduced bone mineral density [39], osteonecrosis cataract [41] plant alkaloids (Vincristine, Vinblastine) peripheral sensory or motor neuropathy [42] radiotherapy secondary malignancy [43,44] cranial radiotherapy neurocognitive long-term issues, clinical leukencephalopathy [30,40] cerebrovascular complications [45][46][47] hormonal deficiency [48][49][50][51] overweight, obesity, metabolic syndrome [52] cataract, ocular toxicity [41] ototoxicity [37] spinal radiotherapy artery disease [53] cardiac toxicity [54] scoliosis/ kyphosis brain surgery neurocognitive deficits [30,40] hormonal deficiency [48][49][50][51] overweight, obesity, metabolic syndrome [52] spinal surgery scoliosis/ kyphosis…”

“…Impaired visual acuity can be caused by compression or invasion of the tumor into the optic nerve, the optic chiasm, or the visual pathway. Additionally, cranial radiotherapy may cause optic neuropathy or cataract [41]. Sellar tumors can cause visual field defects, resulting in hemianopsia.…”

Re-irradiation for recurrent glioma- the NCI experience in tumor control, OAR toxicity and proposal of a novel prognostic scoring system

“…When applying either the Carson 2007 [ 34 ] or the Combs 2013 [ 1 ] scoring system to our data, we did not achieve a statistically significant separation of the curves (Additional file 3 : Figure S2) as has been noted in other published dataset comparisons [ 9 ], this however may reasonably be related to the small sample size in our study as compared to that of other authors Unlike the Carson 2007 scoring system, the Combs 2013 scoring system does not include KPS or steroid use but does include time since previous RT in addition to age and histology. Our scoring system considers the likelihood of controlling the recurrent tumor (target control) based on tumor size, tumor location and presence of diffuse disease parameters derived from our own practice and review of the practice and that of other radiation prominent oncologists (personal communication).…”

Total diagnostic interval in children with brain tumours in a middle-income country: national experience from Serbia

“…As the significance of diagnostic delay for survivorship from paediatric cancers is unclear, the term total diagnostic interval (TDI) is now preferred [2,3]. However, in children with brain tumours, longer TDI might confer a greater risk for the development of neurological sequelae [4][5][6][7]. Multiple factors have been identified to impact TDI, the most prominent being age at diagnosis, parent level of education, type of cancer and presenting symptoms [8].…”