Neuropsychological resiliency after treatment for advanced stage neuroblastoma

Abstract

Summary:The purpose of this study was to describe the neuropsychological functioning of survivors of advanced stage neuroblastoma. In all, 16 survivors, diagnosed at a median of 2.8 years, who had received intensive chemotherapy and surgical treatments, were identified; 11 had received myeloablative consolidation therapy, eight with total body irradiation (TBI). All patients were evaluated with a neuropsychological assessment battery at a median age of 8.8 years. Analyses included comparison of the performances of the TBI group vs the no-TBI group; determination of whether the proportion of individuals with impaired or superior performance on each measure exceeded normative expectations; and performance indexes reflecting patterns of performance. Results indicate no significant deleterious impact of TBI and/or presence or absence of myeloablative therapy on neurocognitive and neurobehavioral functioning. For this cohort, resilience to neuropsychological vulnerability was observed, which included the emergence of a profile of full-scale IQ, verbal IQ, and mathematical achievement well above average expectations. We concluded that the results document a lack of neuropsychological morbidity among this cohort of survivors of advanced stage neuroblastoma, regardless of the inclusion of TBI. Moreover, a striking pattern of excellent neurocognitive functioning with intact neurobehavioral functioning was observed.

Late effects in children treated with intensive multimodal therapy for high-risk neuroblastoma: High incidence of endocrine and growth problems

“…33,34 As in other studies of HR NBL patients, cardiac dysfunction and need for special education, while present, were less common. 35 TBI, mediastinal radiation and/or anthracycline exposure are all possible explanations for cardiotoxicity but were not explored. Other limitations of this study include its retrospective nature, reliance on clinical reports that were often incomplete, and loss of patients to follow-up if they returned to their home institution.…”

Long‐term psychological and educational outcomes for survivors of neuroblastoma: A report from the Childhood Cancer Survivor Study

“…Subsets of neuroblastoma survivors may be vulnerable to long‐term health impairments because of their young age at diagnosis and the specific therapies that they receive. However, late psychological effects of treatment are understudied in this population …”

“…However, late psychological effects of treatment are understudied in this population. [4][5][6][7] In the United States, children with neuroblastoma are diagnosed at a median age of 17.3 months. 8,9 This young age may place them at increased risk for psychological impairment because of contributions from both the early biologic insult to the developing central nervous system 10 and the disruption of normal psychosocial development by intensive cancer treatment.…”

Long-term outcomes in children with high-risk neuroblastoma treated with autologous stem cell transplantation

“…[21][22][23][24] Despite this, neuropsychological and adaptive functioning appear to be well preserved. 25,26 Since 1985, high-risk NB patients at our hospital have been transplanted with an unpurged autologous graft. A previous analysis showed an excellent disease-free survival 27 and the objectives of this study were to update the long-term outcome of these children.…”