title: Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: a report from the Childhood Cancer Survivor Study.
abstract: Medulloblastoma is the most common malignant childhood brain tumor, although long-term risks for chronic neurologic health and psychosocial functioning in aging adult survivors are incompletely characterized.
  
  
  
  The Childhood Cancer Survivor Study (CCSS) includes 380 five-year survivors of medulloblastoma/primitive neuroectodermal tumor (PNET; median age at follow-up: 30 y, interquartile range 24-36) and sibling comparison (n = 4031). Cumulative incidence of neurologic health conditions was reported. Cox regression models provided hazard ratios (HRs) and 95% CIs. Cross-sectional outcomes were assessed using generalized linear models.
  
  
  
  Compared with siblings, survivors were at increased risk of late-onset hearing loss (HR: 36.0, 95% CI: 23.6-54.9), stroke (HR: 33.9, 95% CI: 17.8-64.7), seizure (HR: 12.8, 95% CI: 9.0-18.1), poor balance (HR: 10.4, 95% CI: 6.7-15.9), tinnitus (HR: 4.8, 95% CI: 3.5-6.8), and cataracts (HR: 31.8, 95% CI: 16.7-60.5). Temporal/frontal lobe radiotherapy of 50 Gy or more increased risk for hearing loss (HR: 1.9, 95% CI: 1.1-1.3), seizure (HR: 2.1, 95% CI: 1.1-3.9), stroke (HR: 3.5, 95% CI: 1.3-9.1), and tinnitus (HR: 2.0, 95% CI: 1.0-3.9). Survivors were less likely than siblings to earn a college degree (relative risk [RR]: 0.49, 95% CI: 0.39-0.60), marry (RR: 0.35, 95% CI: 0.29-0.42), and live independently (RR: 0.58, 95% CI: 0.52-0.66).
  
  
  
  Adult survivors of childhood medulloblastoma/PNET demonstrate pronounced risk for hearing impairment, stroke, lower educational attainment, and social independence. Interventions to support survivors should be a high priority.
authors.affiliation: Washington University School of Medicine, Siteman Cancer Center, St. Louis Children's Hospital, and Barnes Jewish Hospital, St. Louis, Missouri, USA.
authors.forename: Allison A
authors.initials: AA
authors.lastname: King
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors.forename: Kristy
authors.initials: K
authors.lastname: Seidel
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors.forename: Chongzhi
authors.initials: C
authors.lastname: Di
authors.affiliation: Fred Hutchinson Cancer Research Center, Seattle, Washington, USA.
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.affiliation: Washington University School of Medicine, Siteman Cancer Center, St. Louis Children's Hospital, and Barnes Jewish Hospital, St. Louis, Missouri, USA.
authors.forename: Stephanie Mabry
authors.initials: SM
authors.lastname: Perkins
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Kevin R
authors.initials: KR
authors.lastname: Krull
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Sklar
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Green
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Gregory T
authors.initials: GT
authors.lastname: Armstrong
authors.affiliation: Mattel Children's Hospital at the University of California Los Angeles, Los Angeles,California, USA.
authors.forename: Lonnie K
authors.initials: LK
authors.lastname: Zeltzer
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Wells
authors.affiliation: The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Stovall
authors.affiliation: Boston Children's Hospital, Boston, Massachusetts, USA.
authors.forename: Nicole J
authors.initials: NJ
authors.lastname: Ullrich
authors.affiliation: Memorial Sloan Kettering Cancer Center, New York, NY, USA.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Oeffinger
authors.affiliation: St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Robison
authors.affiliation: Children's National Health System, Washington, DC, USA.
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Packer
mesh_terms: D000293:Adolescent; D000328:Adult; D000073116:Cancer Survivors / Q000523:psychology*; D002528:Cerebellar Neoplasms / Q000150:complications / Q000473:pathology / Q000532:radiotherapy; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008527:Medulloblastoma / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy; D008569:Memory Disorders / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D018242:Neuroectodermal Tumors, Primitive / Q000150:complications* / Q000473:pathology / Q000532:radiotherapy; D011379:Prognosis; D011446:Prospective Studies; D011878:Radiotherapy / Q000009:adverse effects*; D012189:Retrospective Studies; D013315:Stress, Psychological / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D015996:Survival Rate; D055815:Young Adult
keywords: late effects; medulloblastoma; neurologic outcomes; psychosocial outcomes