Long-term neurocognitive outcomes in adult survivors of childhood medulloblastoma.

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9554 Background: Medulloblastomas are malignant tumors of the posterior fossa that occur in childhood. With the advent of craniospinal radiation (CSI) treatment survival rates improved. However, CSI is associated with progressive decline in neurocognitive function, particularly in younger children. Accelerated aging due to treatment late effects has been suggested, but little is known about the first generation of survivors as they approach middle age. Methods: In this retrospective cohort study, we assessed 17 adults, 8 to 42 years (median 20 years) after diagnosis of medulloblastoma in childhood, treated with surgery, radiation (CSI + post fossa boost: median dose, 35+18 Gy, n=14; CSI only: 45 Gy, n=1; post fossa only: 50 Gy, n=2). Six patients also received chemotherapy. We conducted a cross sectional analysis of their current neurocognitive and physical status. Data from prior neuropsychological assessments conducted 1 to 31 years (median 6.6 years) after diagnosis were available for 15, and we used growth curve analyses to model individual change over time for those 15 participants. Results: All participants exhibited physical and neurocognitive late effects of their disease and treatment. The most common health complications included hearing impairment, second cancers, diabetes, hypertension, and endocrine deficiencies. The group was well below average across multiple neurocognitive domains (e.g., mean full scale IQ = 87.13, SD = 15.03) and 88% required accommodations at school for learning disorders. Longitudinal analyses revealed that verbal abilities and processing speed remained stable decades after treatment was complete, but working memory (β ± SE: -0.5 ± 0.2, p=0.02) and mathematics (β ± SE: -0.96 ± 0.18, p<0.0001) continued to decline. Conclusions: Medulloblastoma survivors face ongoing physical and neurocognitive challenges in adulthood, including progressively impaired working memory and persistently slow processing speed. They have limited resources with which to confront the challenge of aging, given diminished physical, cognitive, and neural reserve. These survivors will require social and economic support when their aging parents are no longer able to care for them. No significant financial relationships to disclose.