Longitudinal evaluation of neurocognitive function after treatment for central nervous system germ cell tumors in childhood

Abstract

BACKGROUND: Central nervous system germ cell tumors (CNS GCT) are typically localized to midline structures of the brain, including the pineal and suprasellar/pituitary regions. Management of these tumors depends on underlying histology (germinoma or nongerminomatous germ cell tumor). Knowledge about neurocognitive outcome in these patients is limited. Longitudinal neurocognitive outcome in CNS GCT patients seen for neuropsychological evaluation at a single institution was explored. METHODS: Thirty‐five patients were seen for neurocognitive evaluation after diagnosis and treatment for a CNS GCT. Mean age at diagnosis was 11.66 years. Tumor location was suprasellar in 12 patients, pineal in 9, bifocal in 10, multifocal in 3, and thalamic in 1. Standardized cognitive tests of intelligence, receptive language, visual‐motor ability, memory, and academic achievement were administered. Longitudinal and cross‐sectional analyses were conducted. RESULTS: Intelligence, academic functioning, and receptive vocabulary were not significantly compromised in most patients treated for CNS GCT. Working memory, information processing speed, and visual memory declined significantly over time in all patients. Patients with pineal tumors showed early and stable deficits, whereas patients with suprasellar and bifocal tumors showed more protracted declines from initial average functioning. Patients treated with ventricular versus craniospinal radiation displayed better outcome. CONCLUSIONS: Although general cognitive abilities appeared stable and intact after treatment for most children with CNS GCT, a significant decline over time in working memory, processing speed, and visual memory was evident. Tumor location appeared to be important in understanding the trajectory of stability and decline in CNS GCT patients, as did radiation field. Cancer 2011;. © 2011 American Cancer Society.

Executive function late effects in survivors of pediatric brain tumors and acute lymphoblastic leukemia

“…Neurologically, the frontal lobes and their connections throughout the brain, including white matter tracts/integrity, are of integral importance to executive function. Not surprisingly, survivors of pediatric cancer have been found to be at risk for impaired executive functions, including both higher- and lower-level skills (Campbell et al, 2009; Conklin, Krull et al, 2012; Jansen, Miaskowski, Dodd, Dowling, & Kramer, 2005; Mabbott et al, 2011; Schatz et al, 2000). …”

New Considerations in Radiation Treatment Planning for Brain Tumors: Neural Progenitor Cell–Containing Niches

“…31,39,40 Reductions in neurocognitive performance have been documented following administration of intrathecal chemotherapy in children with leukemia. 32 Given that the drug penetrates only a thin layer adjacent to the ventricular system, this suggests that periventricular cells may play an important role in neurocognitive function.…”

“…32 Given that the drug penetrates only a thin layer adjacent to the ventricular system, this suggests that periventricular cells may play an important role in neurocognitive function. However, improved neurocognitive performance in patients with central nervous system germ cell tumors who were treated with whole-ventricle radiation when compared with craniospinal radiation has been reported, 40 suggesting that perhaps the cells lining the ventricle may not be as vital as other areas in the brain in neurocognitive sequelae of RT. In addition, only 1 animal study to date has documented a relationship between RT dose to the SVZ and performance on neuropsychological testing, 41 and no human studies have confirmed this relationship.…”

Current concepts and future strategies in the management of intracranial germinoma

“…Patients treated with ventricular versus craniospinal radiation displayed better outcome. The data are, however, difficult to interpret as there was an imbalance between dose prescriptions and treatment volumes according to histological subtype [70]. Only one series investigated neurocognitive function after the present treatment strategy consisting of chemotherapy followed by reduced dose whole ventricular irradiation.…”

“…Data on quality of survival and neurocognitive function are retrospective in nature, based on heterogeneous cohorts of patients including non-germinoma who received more intensive treatments [13,15,19,22,36,42,63,65,67,68,70,71]. Longitudinal observations are often missing and the instruments used considerably vary between series.…”