Cognitive and adaptive outcome in low-grade pediatric cerebellar astrocytomas: evidence of diminished cognitive and adaptive functioning in National Collaborative Research Studies (CCG 9891/POG 9130).
OBJECTIVE
Clinicians often assume that children with posterior fossa tumors are at minimal risk for cognitive or adaptive deficits if they do not undergo cranial irradiation. However, small case series have called that assumption into question, and have also suggested that nonirradiated cerebellar tumors can cause location-specific cognitive and adaptive impairment. This study (1) assessed whether resected but not irradiated pediatric cerebellar tumors are associated with cognitive and adaptive functioning deficits, and (2) examined the effect of tumor location and medical complications on cognitive and adaptive functioning.


METHODS
The sample was composed of 103 children aged 3 to 18 years with low-grade cerebellar astrocytomas, who underwent only surgical treatment as part of Children's Cancer Group protocol 9891 or Pediatric Oncology Group protocol 9130. The sample was divided into three groups based on primary tumor location: vermis, left hemisphere, or right hemisphere. Data were collected prospectively on intelligence, academic achievement, adaptive skills, behavioral functioning, and pre-, peri-, and postsurgical medical complications.


RESULTS
The sample as a whole displayed an elevated risk for cognitive and adaptive impairment that was not associated consistently with medical complications. Within this group of children with cerebellar tumors, tumor location had little effect on cognitive, adaptive, or medical outcome.


CONCLUSIONS
We did not replicate previous findings of location-specific effects on cognitive or adaptive outcome. However, the elevated risk of deficits in this population runs contrary to clinical lore, and suggests that clinicians should attend to the functional outcomes of children who undergo only surgical treatment for cerebellar tumors.
Beebe
Dean W
DW
Cincinnati Children's Hospital Medical Center, The University of Cincinnati School of Medicine, Cincinnati, OH 45229-3039, USA. dean.beebe@cchmc.org
Ris
M Douglas
MD
Armstrong
F Daniel
FD
Fontanesi
John
J
Mulhern
Raymond
R
Holmes
Emi
E
Wisoff
Jeffrey H
JH
D000223:Adaptation, Psychological; D000293:Adolescent; D001254:Astrocytoma / Q000150:complications* / Q000523:psychology*; D002528:Cerebellar Neoplasms / Q000150:complications* / Q000523:psychology*; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D006801:Humans; D007360:Intelligence; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors