title: Long-term neurologic and neurosensory sequelae in adult survivors of a childhood brain tumor: childhood cancer survivor study.
abstract: OBJECTIVE
  To describe the neurologic and neurosensory deficits in children with brain tumors (BTs), compare incidence of these deficits with that of a sibling control group, and evaluate the factors associated with the development of these deficits.
  
  
  METHODS
  Detailed questionnaires were completed on 1,607 patients diagnosed between 1970 and 1986 with a primary CNS tumor. Neurosensory and neurologic dysfunctions were assessed and results compared with those of a sibling control group. Medical records on all patients were abstracted, including radiotherapy dose and volume.
  
  
  RESULTS
  Seventeen percent of patients developed neurosensory impairment. Relative to the sibling comparison group, patients surviving BTs were at elevated risk for hearing impairments (relative risk [RR], 17.3; P = <.0001), legal blindness in one or both eyes (RR, 14.8; P = <.0001), cataracts (RR, 11.9; P = <.0001), and double vision (RR, 8.8; P = <.0001). Radiation exposure greater than 50 Gy to the posterior fossa was associated with a higher likelihood of developing any hearing impairment. Coordination and motor control problems were reported in 49% and 26%, respectively, of survivors. Children receiving at least 50 Gy to the frontal brain regions had a moderately elevated risk for motor problems (RR, 2.0; P <.05). Seizure disorders were reported in 25% of patients, including 6.5% who had a late first occurrence. Radiation dose of 30 Gy or more to any cortical segment of the brain was associated with a two-fold elevated risk for a late seizure disorder.
  
  
  CONCLUSIONS
  Children surviving BTs are at significant risk for both early and late neurologic or neurosensory sequelae. These sequelae need to be prospectively monitored.
authors.affiliation: Department of Neurology, Center for Neuroscience and Behavioral Medicine, Children's National Medical Center, Washington, DC, USA. rpacker@cnmc.org.
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Packer
authors.forename: James G
authors.initials: JG
authors.lastname: Gurney
authors.forename: Judy A
authors.initials: JA
authors.lastname: Punyko
authors.forename: Sarah S
authors.initials: SS
authors.lastname: Donaldson
authors.forename: Peter D
authors.initials: PD
authors.lastname: Inskip
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Ann C
authors.initials: AC
authors.lastname: Mertens
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.forename: H Stacy
authors.initials: HS
authors.lastname: Nicholson
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Neglia
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000628:therapy*; D016022:Case-Control Studies; D002648:Child; D004827:Epilepsy / Q000209:etiology; D005260:Female; D006311:Hearing Disorders / Q000209:etiology; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology*; D016012:Poisson Distribution; D016016:Proportional Hazards Models; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017741:Survivors; D014786:Vision Disorders / Q000209:etiology