Late effects in survivors of childhood CNS tumors treated on Head Start I and II protocols.
BACKGROUND
Due to the devastating late effects associated with cranial irradiation in young children with central nervous system (CNS) tumors, treatment for these patients has evolved to include the use of intensive chemotherapy to either avoid or postpone irradiation. While survival outcomes have improved, late effects data in survivors treated on such regimens are needed.


OBJECTIVE
This multi-institutional study comprehensively describes late effects in survivors treated on the Head Start I/II protocols.


METHODS
Survivors of CNS tumors treated on Head Start I/II protocols were enrolled. Late effects data were collected using a validated parent-report questionnaire. Social, emotional, and behavioral functioning and quality of life were assessed using parent-report on the BASC-2 and CHQ-PF50 questionnaires.


RESULTS
Twenty-one survivors (medulloblastoma = 13, sPNET = 4, ATRT = 1, ependymoma = 3) were enrolled. Ten (48%) were irradiation-free. Late effects (frequency; median time of onset since diagnosis) included ≥ grade III hearing loss (67%; 3.9 years), vision (67%; 4.1 years), hypothyroidism (33%; 4 years), growth hormone (GH) deficiency (48%; 4.7 years), dental (52%; 7.1 years), and no cases of secondary leukemia. Irradiation-free (vs. irradiated) survivors reported low rates of hypothyroidism (0/10 vs. 7/11; P = 0.004) and GH deficiency (2/10 vs. 8/11; P = 0.03). The BASC-2 and CHQPF-50 mean composite scores were within average ranges relative to healthy comparison norms. Neither age at diagnosis nor irradiation was associated with these scores.


CONCLUSIONS
Irradiation-free Head Start survivors have lower risk of hypothyroidism and GH deficiency. Secondary leukemias are not reported. With extended follow-up, survivors demonstrate quality of life, social, emotional, and behavioral functioning within average ranges.
New York University Langone Medical Center, New York, New York.
Aniket
A
Saha
Christina G
CG
Salley
Preeti
P
Saigal
Linda
L
Rolnitzky
Judith
J
Goldberg
Suzanne
S
Scott
Randal
R
Olshefski
Juliette
J
Hukin
Stephen A
SA
Sands
Jonathan
J
Finlay
Sharon L
SL
Gardner
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects*; D016543:Central Nervous System Neoplasms / Q000150:complications / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006130:Growth Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D034381:Hearing Loss / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D007223:Infant; D008297:Male; D011379:Prognosis; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors; D014786:Vision Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000401:mortality; D055815:Young Adult
CNS tumor survivors; CNS tumors; Head Start; late effects; quality of life