title: Long-Term Neurocognitive Functioning and Social Attainment in Adult Survivors of Pediatric CNS Tumors: Results From the St Jude Lifetime Cohort Study.
abstract: OBJECTIVE
  To assess the prevalence and severity of neurocognitive impairment in adult survivors of pediatric CNS tumors and to examine associated treatment exposures.
  
  
  METHODS
  Participants included 224 survivors of CNS tumors who were treated at St Jude Children's Research Hospital (current median age [range], 26 years [19 to 53 years]; time from diagnosis, 18 years [11 to 42 years]) and completed neurocognitive testing. Information on cranial radiation therapy (CRT) doses and parameters of delivery were abstracted from medical records. The prevalence of severe impairment (ie, at least two standard deviations below normative mean) was compared across radiation treatment groups (no CRT, focal irradiation, craniospinal irradiation) using the χ(2) test. Log-binomial models were used to estimate risk ratios (RRs) and corresponding 95% CIs for severe impairment.
  
  
  RESULTS
  In multivariable models, craniospinal irradiation was associated with a 1.5- to threefold increased risk of severe impairment compared with no CRT (eg, intelligence: RR = 2.70; 95% CI, 1.37 to 5.34; memory: RR = 2.93; 95% CI, 1.69 to 5.08; executive function: RR = 1.74; 95% CI, 1.24 to 2.45). Seizures were associated with impaired academic performance (RR = 1.48; 95% CI, 1.02 to 2.14), attention (RR = 1.54; 95% CI, 1.12 to 2.13), and memory (RR = 1.44; 95% CI, 1.04 to 1.99). Hydrocephalus with shunt placement was associated with impaired intelligence (RR = 1.78; 95% CI, 1.12 to 2.82) and memory (RR = 1.42; 95% CI, 1.03 to 1.95). Differential follow-up time contributed to variability in prevalence estimates between survivors treated with older nonconformal and those treated with more contemporary conformal radiation therapy methods. Neurocognitive impairment was significantly associated with lower educational attainment, unemployment, and nonindependent living.
  
  
  CONCLUSIONS
  Survivors of pediatric CNS tumors are at risk of severe neurocognitive impairment in adulthood. The prevalence of severe impairment is greater than expected in the general population, even in the absence of CRT, and is associated with disrupted attainment of adult social milestones.
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN. tara.brinkman@stjude.org.
authors.forename: Tara M
authors.initials: TM
authors.lastname: Brinkman
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Krasin
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Wei
authors.initials: W
authors.lastname: Liu
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Rohit P
authors.initials: RP
authors.lastname: Ojha
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Zsila S
authors.initials: ZS
authors.lastname: Sadighi
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Gupta
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Cara
authors.initials: C
authors.lastname: Kimberg
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Deokumar
authors.initials: D
authors.lastname: Srivastava
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Amar
authors.initials: A
authors.lastname: Gajjar
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.affiliation: All authors: St Jude Children's Research Hospital, Memphis, TN.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
mesh_terms: D000328:Adult; D002493:Central Nervous System Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D016543:Central Nervous System Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D016009:Chi-Square Distribution; D003071:Cognition; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D016371:Cranial Irradiation / Q000009:adverse effects; D004522:Educational Status; D005260:Female; D006801:Humans; D057187:Independent Living / Q000523:psychology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009483:Neuropsychological Tests; D016017:Odds Ratio; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012919:Social Behavior; D017741:Survivors / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D014478:Unemployment / Q000523:psychology; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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