Abstract
The treatment of children with posterior fossa brain tumours (PFBT) impacts their long term functional and imaging outcomes. This study aimed to evaluate academic achievement correlated with long-term sequelae after different PFBT treatment modalities. The study cohort consisted of 110 survivors (median age at diagnosis 10.1 years and median time of follow up 13.2 years) who completed hearing questionnaires, neurological assessment and MRI of the brain ≥5 years after the end of treatment. There were three treatment groups. A cisplatin group which underwent cisplatin chemotherapy, radiotherapy and surgery (medulloblastoma N = 40), a radiotherapy group which underwent radiotherapy and surgery (astrocytoma/ependymoma N = 30), and a surgery group (astrocytoma N = 40). Academic achievement was correlated to the age at diagnosis, ototoxicity, Karnofsky score (KS), and MRI findings (Fazekas Score (FS)- treatment related parenchymal changes). For a modelled age at diagnosis of five years, the cisplatin group had lower academic achievements compared to the radiotherapy (p = 0.028) and surgery (p = 0.014) groups. Academic achievements evaluated at a modelled age of 10 years at diagnosis did not significantly differ among the treatment groups. The cisplatin group exhibited a higher occurrence of ototoxicity than the radiotherapy (p<0.019) and surgery groups (p<0.001); however, there was no correlation between ototoxicity and academic achievements (p = 0.722) in older age at diagnosis. The radiotherapy group exhibited lower KS than the surgery group (p<0.001). KS significantly influenced academic achievements in all groups (p<0.000). The cisplatin group exhibited higher FS than the surgery group (p<0.001) while FS did not correlate with academic achievement (p = 0.399). Older age is a protective factor for academic achievements irrespective of a treatment modality.
Highlights
With the advent of modern treatment approaches, more than 70% of children diagnosed with primary Central Nervous System (CNS) cancers are surviving longer than five years after the end of treatment [1,2,3]
Age at diagnosis strongly influences academic achievements in Posterior fossa brain tumour (PFBT) survivors The modelled age of 5 years at diagnosis for the cisplatin group exhibited significantly decreased academic achievements compared to the radiotherapy and surgery groups
Severe ototoxicity was present in 35% of patients in the cisplatin group compared to 20% of patients in the radiotherapy group, what is in accordance with previous ototoxicity studies [1, 15, 16]
Summary
With the advent of modern treatment approaches, more than 70% of children diagnosed with primary Central Nervous System (CNS) cancers are surviving longer than five years after the end of treatment [1,2,3]. Chemoirradiation and tumour-related effects lead to other long-term consequences, including neurocognitive deficits such as learning and memory deficits [1, 4]. This can negatively influence academic achievements [3, 4, 7, 8]. There has been no published study of PFBT survivors and correlations between academic achievement, MRI findings and late effect sequelae with a median follow-up longer than 12 years
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