title: Long-term quality of life in children treated for posterior fossa brain tumors.
abstract: OBJECTIVE
  In the face of increasing survival, quality of life (QOL) has become an important indicator of treatment success in children with posterior fossa brain tumors (PFBTs). The authors' objective was to assess the long-term QOL in survivors of PFBT.
  
  
  METHODS
  The authors conducted a cross-sectional study of children who, between birth and age 18 years at diagnosis, had previously been treated at their institution for a PFBT. At the time of assessment for this study, children were between 5 and 19 years old and had received standard treatment for PFBT ending at least 6 months before the assessment. The QOL was measured with the Pediatric Quality of Life Inventory (PedsQL) generic score scales and the Health Utilities Index Mark 3 (HUI3). Multivariate analyses were used to assess several variables (patient related, treatment related, and socioeconomic) for association with QOL.
  
  
  RESULTS
  A total of 62 children participated in the study (median age at assessment 11.9 years, interquartile range [IQR] 7.8-14.8, and median age at tumor diagnosis of 4.9 years, IQR 2.5-6.9). Median time since active treatment for their PFBT was 5.2 years (IQR 2.4-10.1). Tumor types included cerebellar pilocytic astrocytoma (45.2%), medulloblastoma (30.6%), ependymoma (11.3%), and brainstem astrocytoma (11.3%). Adjuvant therapy included chemotherapy (40.3%) or radiotherapy (14.5% focal and 21.0% craniospinal radiotherapy). Permanent treatment for hydrocephalus was required in 38.7% of the patients. Tumors recurred in 11.3%, requiring repeat treatment in these patients. The median HUI3 utility score was 0.91 (IQR 0.71-1.00) and the median PedsQL total score was 78.3 (IQR 64.1-92.4). Only the following variables were significantly associated with decreased QOL in multivariable model testing (all p < 0.05): need for permanent hydrocephalus treatment, large ventricle size, decreased family functioning, and lower family income.
  
  
  CONCLUSIONS
  As a group, long-term survivors of pediatric PFBT appear to have QOL indicators that are similar to those of the general population, although a reasonable minority of patients experience poor outcomes. Although several confounding variables likely remain in this retrospective study, important associations with QOL include the presence of hydrocephalus and socioeconomic factors. The study sample size, however, was limited and the presence of other important factors cannot be excluded.
authors.affiliation: Divisions of Neurosurgery, Hospital for Sick Children, University of Toronto, Ontario, Canada. abhaya.kulkarni@sickkids.ca.
authors.forename: Abhaya V
authors.initials: AV
authors.lastname: Kulkarni
authors.forename: Janine
authors.initials: J
authors.lastname: Piscione
authors.forename: Iffat
authors.initials: I
authors.lastname: Shams
authors.forename: Eric
authors.initials: E
authors.lastname: Bouffet
mesh_terms: D000293:Adolescent; D001254:Astrocytoma / Q000523:psychology / Q000628:therapy; D020295:Brain Stem Neoplasms / Q000523:psychology / Q000628:therapy; D002528:Cerebellar Neoplasms / Q000523:psychology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004806:Ependymoma / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000453:epidemiology / Q000209:etiology; D015192:Infratentorial Neoplasms / Q000523:psychology* / Q000628:therapy*; D008297:Male; D008527:Medulloblastoma / Q000523:psychology / Q000628:therapy; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D011788:Quality of Life; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D017741:Survivors / Q000523:psychology / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome