title: Neurocognitive outcomes in pediatric and adolescent patients with central nervous system germinoma treated with a strategy of chemotherapy followed by reduced-dose and volume irradiation.
abstract: BACKGROUND
  Evaluation of neurocognitive outcomes after a treatment strategy of chemotherapy followed by reduced-dose and volume irradiation for primary central nervous system (CNS) germinoma.
  
  
  METHODS
  Neuropsychological evaluations including measures of verbal and nonverbal intellectual functioning, working memory, processing speed, verbal and nonverbal memory, executive functioning, depression, anxiety, and social functioning were analyzed for all patients (N = 20) with histologically diagnosed CNS germinoma diagnosed at our institution between 2003 and 2009. All 20 patients underwent at least one neuropsychological evaluation, 14 patients had at least two evaluations, 7 patients had at least three, and 2 had four, generating a total of 43 test batteries at a mean of 3.0 years from diagnosis.
  
  
  RESULTS
  The 20 patients performed as a group in the average range on all neurocognitive measures administered when compared to the nonmedical normative group. No decline over time was indicated on any of the neurocognitive measures. An improvement over time was indicated for nonverbal reasoning, nonverbal memory, processing speed, working memory, response inhibition, and cognitive flexibility. No significant differences were found by tumor location, age at diagnosis, or hydrocephalus at presentation.
  
  
  CONCLUSIONS
  For pediatric and adolescent patients with newly diagnosed CNS germinoma, modest chemotherapy followed by reduced dose ventricular field irradiation with simultaneous integrated boost to the primary site, is associated with preservation of neurocognitive, social and emotional functioning.
authors.affiliation: Neural Tumors Program, Center for Cancer and Blood Diseases, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA. shoneil@chla.usc.edu
authors.forename: Sharon
authors.initials: S
authors.lastname: O'Neil
authors.forename: Lingyun
authors.initials: L
authors.lastname: Ji
authors.forename: Cathliyn
authors.initials: C
authors.lastname: Buranahirun
authors.forename: Jaye
authors.initials: J
authors.lastname: Azoff
authors.forename: Girish
authors.initials: G
authors.lastname: Dhall
authors.forename: Soumen
authors.initials: S
authors.lastname: Khatua
authors.forename: Sunita
authors.initials: S
authors.lastname: Patel
authors.forename: Ashok
authors.initials: A
authors.lastname: Panigrahy
authors.forename: Mark
authors.initials: M
authors.lastname: Borchert
authors.forename: Richard
authors.initials: R
authors.lastname: Sposto
authors.forename: Jonathan
authors.initials: J
authors.lastname: Finlay
mesh_terms: D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D003071:Cognition / Q000187:drug effects* / Q000528:radiation effects*; D003131:Combined Modality Therapy; D005047:Etoposide / Q000008:administration & dosage / Q000009:adverse effects; D018237:Germinoma / Q000628:therapy*; D006801:Humans; D009483:Neuropsychological Tests; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage; D055815:Young Adult
chemical_list: D005047:Etoposide; D016190:Carboplatin