title: Diffusion Tensor Imaging and Neurobehavioral Outcome in Children With Brain Tumors Treated With Chemotherapy.
abstract: BACKGROUND
  Childhood brain tumor survivors (CBTS) often experience treatment-related neurocognitive deficits affecting quality of life (QOL), but systemic chemotherapy contributions to outcomes are unclear. Our objective was to relate brain tissue changes to neurocognitive and QOL effects after systemic myeloablative chemotherapy with autologous hematopoietic progenitor cell rescue in CBTS.
  
  
  METHODS
  Regional brain volumes and diffusion tensor indices were correlated with neurocognitive, behavioral, and QOL measures, and compared between 8 CBTS (mean age 8.5 years, mean age at diagnosis 32 months), and 9 healthy controls (mean 9.3 years).
  
  
  RESULTS
  Overall QOL, school, and psychosocial functioning were significantly lower in patients (P < .05). Most patients scored within normative ranges on neurocognitive and behavioral assessment. Elevated mean diffusivity and decreased fractional anisotropy, indicating gray and white matter injury, respectively, appeared in memory and executive functioning areas. Low scores on Inhibition on the Neuropsychological Assessment-II were correlated with elevated mean diffusivity in prefrontal cortex.
  
  
  CONCLUSIONS
  Brain injury, decreased QOL, and to a lesser extent, executive functioning deficits appear in CBTS treated with myeloablative chemotherapy and autologous hematopoietic progenitor cell rescue. Early cognitive and psychological assessment and intervention are warranted in this population.
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA UCLA School of Nursing, Los Angeles, CA, USA mbnelson@chla.usc.edu.
authors.forename: Mary
authors.initials: M
authors.lastname: Baron Nelson
authors.affiliation: UCLA School of Nursing, Los Angeles, CA, USA Georgetown University, Washington, DC, USA.
authors.forename: Peggy
authors.initials: P
authors.lastname: Compton
authors.affiliation: UCLA School of Nursing, Los Angeles, CA, USA David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Macey
authors.affiliation: City of Hope, Duarte, CA, USA.
authors.forename: Sunita K
authors.initials: SK
authors.lastname: Patel
authors.affiliation: UCLA School of Nursing, Los Angeles, CA, USA.
authors.forename: Eufemia
authors.initials: E
authors.lastname: Jacob
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, CA, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: O'Neil
authors.affiliation: UCLA School of Nursing, Los Angeles, CA, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ogren
authors.affiliation: Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Finlay
authors.affiliation: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Harper
mesh_terms: D016880:Anisotropy; D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001921:Brain / Q000187:drug effects / Q000473:pathology*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000503:physiopathology*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000139:chemically induced*; D056324:Diffusion Tensor Imaging; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011788:Quality of Life; D017741:Survivors
chemical_list: D000970:Antineoplastic Agents
keywords: adverse effects; central nervous system tumors; chemotherapy; cognitive functioning