Impairments of Attention Following Treatment With Cranial Irradiation and Chemotherapy in Children

Anderson, Vicki; Godber, Tim; Smibert, Elizabeth; Weiskop, Sophie; Ekert, H.

doi:10.1080/13803390409609792

Cited by 32 publications

(17 citation statements)

References 46 publications

(46 reference statements)

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“…Side effects of radiotherapy include dysfunction of the hy pothalamicpituitary axis and visual apparatus, benign and malignant radiationinduced CNS tumors, cognitive and at tentional deficits, and cerebrovasculopathy/moyamoya dis ease. [5][6][7]26,28,29,31,36,37,41,51,52,60,63,64,72,75,84,87,88,90,96,97,102,105,106 These effects are more pronounced in younger children 64,75 and are correlated with increasing target volume and total dos age. 28,36,72,86,87 These late effects must be recognized when comparing risk-benefit profiles of radical versus limited resection and radiotherapy.…”

Section: Side Effects Of Radiation Therapy and Impact On Reoperationmentioning

confidence: 85%

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Elliott¹,

Hsieh²,

Hochm

et al. 2010

PED

163

148

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Object Optimal treatment of primary and recurrent craniopharyngiomas remains controversial. Radical resection and limited resection plus radiation therapy yield similar rates of disease control and overall survival. The data are much less clear for recurrent tumors. The authors report their experience with radical resection of both primary and recurrent craniopharyngiomas in children and compare the outcomes between the 2 groups. Methods A retrospective analysis was performed in 86 children younger than 21 years of age who underwent a total of 103 operations for craniopharyngioma between 1986 and 2008; these were performed by the senior author. The goal was resection with curative intent in all patients. Two patients were lost to follow-up and were excluded from analysis. The mean age at the time of surgery was 9.6 years, and the mean follow-up was 9.0 years. Results All 57 children with primary tumors underwent gross-total resection (GTR). A GTR was achieved in significantly fewer children with recurrent tumors (18 [62%] of 29). There were 3 perioperative deaths (3%). Tumor recurred after GTR in 14 (20%) of 71 patients. Overall survival and progression-free survival were significantly better in patients with primary tumors at time of presentation to the authors' institution. There were no significant differences in the neurological, endocrinological, visual, or functional outcomes between patients with primary and those with recurrent tumors. Factors negatively affecting overall survival and progression-free survival include subtotal resection (recurrent tumors only), tumor size ≥ 5 cm, or presence of hydrocephalus or a ventriculoperitoneal shunt. Prior radiation therapy and increasing tumor size were both risk factors for incomplete resection at reoperation. Conclusions In the hands of surgeons with experience with craniopharyngiomas, the authors believe that radical resection at presentation offers the best chance of disease control and potential cure with acceptable morbidity. While GTR does not preclude recurrence and is more difficult to achieve in recurrent tumors, especially large and previously irradiated tumors, radical resection is still possible in patients with recurrent craniopharyngiomas with morbidity similar to that of primary tumors.

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Section: Side Effects Of Radiation Therapy and Impact On Reoperationmentioning

confidence: 85%

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Elliott¹,

Hsieh²,

Hochm

et al. 2010

PED

163

148

View full text Add to dashboard Cite

show abstract

“…More pronounced in younger children, 41,42 side effects of RT include dysfunction of the hypothalamic-pituitary axis, vision decline, benign and malignant radiation-induced CNS tumors, cognitive dysfunction, attentional deficits, cerebrovasculopathy, and moyamoya disease. 1,2,16,18,19,24,36,40,45,60 Prior work by our group 20 and others 54 has shown significantly worse surgical outcomes and survival following tumor progression after failed RT. Given the 20-30% incidence of tumor progression following RT, 9 one must consider the potentially deleterious effects of early irradiation on the safety and efficacy of subsequent treatments.…”

mentioning

confidence: 99%

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome

Elliott¹,

Sands

Strom³

et al. 2010

FOC

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Object Controversy persists concerning the optimal treatment of craniopharyngiomas in children, and no standard outcome metric exists for comparison across treatment modalities, nor is there one that adequately reflects the multisystem dysfunction that may arise. Methods The authors retrospectively analyzed the records of 86 consecutive children who underwent a uniform treatment paradigm of attempted radical resection performed by a single surgeon. Excluding 3 perioperative deaths and 3 patients with inadequate follow-up, 80 children (34 girls and 46 boys; mean age 9.56 years; mean follow-up 9.6 years) composed the study group (53 primary and 27 previously treated/recurrent tumors). Building on existing classification schemes proposed by De Vile for hypothalamic dysfunction and Wen for overall functional outcome, the authors devised a more nuanced classification system (Craniopharyngioma Clinical Status Scale [CCSS]) that assesses outcome across 5 axes, including neurological examination, visual status, pituitary function, hypothalamic dysfunction, and educational/occupational status at last follow-up (there is a 4-tiered grading scale in each domain, with increasing values reflecting greater dysfunction). Results There was a significant increase in pituitary dysfunction following treatment—consistent with the high rates of diabetes insipidus and hypopituitarism common to the surgical management of craniopharyngiomas—and less dramatic deterioration in hypothalamic function or cognitive domains. Significant improvement in vision was also demonstrated, with no significant overall change in neurological status. Preoperative CCSS scores predicted postoperative outcome better than clinical characteristics like patient age, sex, tumor size, and the location or presence of hydrocephalus. Conclusions Preoperative CCSS scores predicted outcome with higher accuracy than clinical or imaging characteristics. In lieu of randomized trials, the CCSS may provide a useful outcome assessment tool for comparison across treatment paradigms and surgical approaches. Long-term follow-up is critical to the analysis of outcomes of craniopharyngioma treatment, given the often-delayed sequelae of all therapies and the high recurrence rates of these tumors.

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“…The Childhood Cancer Survivor Study (CCSS), a multi-center follow-up study, utilized a comprehensive questionnaire to survey outcomes for individuals treated for cancer as children. These children have an increased risk for poor academic performance, thought to evolve from their cognitive deficits, which can involve attention, speed of processing, engagement, fluid cognitive skills, and executive functions [Anderson et al, 2004;Mulhern and Butler, 2004;Spiegler et al, 2004;Mabbott et al, 2008]. According to the CCSS, 23% of survivors were enrolled in special education services, a risk that was further elevated among children who had been treated with CNS prophylaxis (intrathecal methotrexate, cranial irradiation) [Mitby et al, 2003].…”

Section: Late Effectsmentioning

confidence: 99%

Developmental perspectives on optimizing educational and vocational outcomes in child and adult survivors of cancer

Rey‐Casserly

Meadows

2008

Dev Disabil Res Revs

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Over the last few decades, long-term survival rates of children diagnosed with the two most common forms of childhood cancer, acute lymphoblastic leukemia (ALL) and brain tumors have improved substantially. Neurodevelopmental and psychosocial sequelae resulting from these diseases and their treatment have a direct impact on the developing brain and on the quality of life of these children and their families. The focus of this article is on optimizing neuropsychological and adaptive outcomes for children who have been successfully treated for these cancers and whose prospects for long-term survival are increasingly encouraging. We present a model for understanding systemic interactions among the multiple factors that influence the child's development over time and take into account contextual variables. Strategies for optimizing cognitive and psychosocial outcomes or ameliorating late effects need to consider treatment histories, specific stages of development, the contextual demands/developmental challenges associated with each, and the resources (internal and external to the child) available to meet these challenges. The challenges faced by survivors at the early childhood, middle childhood, adolescent, and emerging adulthood stages are discussed. We review different types of interventions and discuss how these can contribute to optimal functioning in survivors of childhood ALL and brain tumors.

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Impairments of Attention Following Treatment With Cranial Irradiation and Chemotherapy in Children

Cited by 32 publications

References 46 publications

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Efficacy and safety of radical resection of primary and recurrent craniopharyngiomas in 86 children

Craniopharyngioma Clinical Status Scale: a standardized metric of preoperative function and posttreatment outcome

Developmental perspectives on optimizing educational and vocational outcomes in child and adult survivors of cancer

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