The long-term outcome of childhood brain tumours: impact of radiotherapy

Dr Sally DavisRegistered Clinical

Psychologist

Background

Second most common form of childhood cancer

Increase in incidence NZ amongst highest (3.42/100,000

children) Increased survival rates & quality of

survival? Identified cognitive deficits Beyond 5 years post-treatment???

Aims

Long-term (> 5 years) effects of radiotherapy (RT)

Specific areas of neuropsychological functioning

Adaptive functioning (QOL, Coping)

Relationships between treatment factors, late effects, and performance

Information gathered

Treatment factors Age at diagnosis Time since

surgery Duration of

symptoms Hydrocephalus Shunt Meningitis Cerebellar

mutism syndrome

Amount of tumour removed

Length of hospital stay

Late effects Balance

problems Hearing loss Left/right sided

weakness Ataxia Alopecia Growth hormone

deficiency Vision

loss/blurry vision Speech problems Gait disturbance

Posterior fossa

Benign versus malignant

Benign (PA) low-grade (Grade

I and II) slow growing small with

distinct borders don’t spread to

distant sites easily removed

surgically surgery alone is

often effective as little risk of further growth

Malignant (MB) aggressive

(Grade IV) grow rapidly large, lacking

distinct borders infiltrate

surrounding tissue

difficult to surgically remove completely

remaining tissue following surgery continues to grow

Participants

20 Medulloblastoma (MB) Mean age at dx = 10 yrs Mean no. of yrs post-dx = 17 yrs

19 Pilocytic astrocytoma (PA) Mean age at dx = 12 yrs Mean no. of yrs post-dx = 14 yrs

20 control subjects

Methodology

Measures Numerous (15) neuropsychological tests Coping Response Inventory (Moos, 1993) Quality of Life Inventory (Frisch, 1994)

Data Analysis T-tests ANOVA (one-way between groups) MANOVA Chi-square tests Bivariate correlations (two-tailed)

Data analysis

Measures MB PA Control

Neuropsychometrics mean sd mean sd mean sd

Verbal IQ 96.15 11.78 104.05 13.53 111.90 7.87

Performance IQ 97.30 15.81 111.68 10.17 116.85 10.90

Full Scale IQ 96.40 14.14 108.63 11.86 115.35 8.62

CVLT trial 1-5 -1.18 0.98 -0.21 1.10 0.28 0.98

Long delay free recall -1.38 1.10 -0.45 1.04 -0.43 0.80

VPA total 3 -1.44 1.67 -0.06 1.04 0.11 0.64

Rey copy -1.66 2.47 -1.66 2.01 -0.71 1.34

Rey recall -1.86 1.11 -0.67 0.96 -0.14 0.95

COWA total -2.37 2.02 -1.37 1.75 -0.59 1.55

Trails B -3.00 2.82 -0.69 1.13 0.27 1.02

PSI (Index score) 76.20 10.60 92.80 14.52 105.65 11.95

LM I -0.83 1.10 -0.09 1.18 0.17 0.87

LM II -1.13 1.15 -0.14 1.13 0.50 0.81

NB: pink box sig different (p<.01) from MB group, yellow box sig different (p<.05) from MB group

Data analysis contd.

Measures MB PA Control

QOL – raw scores mean sd mean sd mean sd

Health 1.9 2.731 1.541 3.361 2.727 2.529

Self esteem 2.1 2.489 1.916 3.322 3.772 1.445

Goal/value 2.75 2.291 2.666 2.16 3.272 1.75

Money 1.45 1.637 0.4583 1.91 1 1.745

Work 1.95 1.986 1.208 2.225 1.818 2.322

Play 1.45 2.584 3.041 2.742 3.272 2.433

Learn 1.05 2.258 1.291 2.367 3.227 1.716

Love 1.05 3.72 2.291 3.758 1.909 3.584

Friend 3.45 2.459 3.833 3.157 4.181 1.942

Relate 4.5 1.933 3.041 2.955 3.318 2.589

Home 3.7 1.894 2.833 2.389 2.136 1.807

Neighbour 2 1.622 1.541 1.864 2.545 2.303

QOL overall 2.3 0.7327 2.0420.858

7 1.909 0.6838

NB: pink box = sig different (p<.05) from MB group, yellow box indicates nearing significant difference

Main findings

RT has a profound long-term negative impact on neuropsychological functioning

Deficits in MB and PA groups found in: Information Processing Speed Attention Executive functioning Memory Fine motor speed

Main findings contd.

Younger at diagnosis = greater risk of neuropsychological deficits

Hydrocephalus and shunt ↓ performance

No significant relationship between neuropsychological performance and total RT dose or amount of tumour removed

Main findings contd.

↑ total number of pre- and post-surgical complications was related to ↓ performance

↑ duration of symptoms prior to diagnosis had a negative impact on Learning

Increased time since surgery was related to an increased satisfaction in QOL

Limitations

These include:

Small sample sizes Self-selection Participants treated between 1980

and 2003

Implications

Are families being fully informed of the long-term impact of treatment required?

LEAP began July 2006 (Akld, Chch, Wgtn) National paediatric oncology initiative Clinical psychologist and paediatric

oncologist Long-term follow-up for survivors of

childhood cancer (20 years post-treatment)

“Ultimately, cure is about controlling the disease, but is also

about preserving dreams and maximising potential.” (Eiser,

2004)

Thank you to: Dr Suzanne Barker-Collo

Dr Lynette Tippett