Buizer Annemieke I, de Sonneville Leo M J, van den Heuvel-Eibrink Marry M, Veerman Anjo J P
Department of Pediatric Hematology-Oncology, VU University Medical Center, Amsterdam, Netherlands.
Cancer. 2006 May 1;106(9):2067-75. doi: 10.1002/cncr.21820.
The improved prognosis of childhood cancer makes monitoring of functional outcome important. The purpose of this study was to evaluate behavioral and educational functioning in survivors of childhood acute lymphoblastic leukemia (ALL) or a Wilms tumor. In this study, children with ALL received central nervous system directed chemotherapy without cranial irradiation.
In a multicenter study, behavioral functioning and school performance was examined in 199 children age 4 to 18. Sixty-four children were at least 1 year from finishing treatment with chemotherapy for ALL (n = 28) or a Wilms tumor (n = 36). They were compared with siblings (n = 37) and with a control group of healthy schoolchildren (n = 98).
A moderately increased risk of behavioral and educational problems was found in children with ALL but not in children with Wilms tumor. School performance was poorer in children with ALL attending primary school compared with same-age peers; however, the rate of utilization of special education services was low. Teacher-rated behavior and mathematics performance was correlated with attention function in children with ALL. An excess of problem behavior and underperformance at school was found in the ALL high-risk group compared with the standard-risk group. No differences were found between siblings and controls.
Evidence is provided of subtle but significant behavioral and educational problems in survivors of childhood ALL, but no dysfunctions in survivors of a Wilms tumor. Careful follow-up of children with ALL treated with chemotherapy only is warranted.
儿童癌症预后的改善使得对功能结局的监测变得重要。本研究的目的是评估儿童急性淋巴细胞白血病（ALL）或肾母细胞瘤幸存者的行为和教育功能。在本研究中，ALL患儿接受了中枢神经系统定向化疗但未进行颅脑照射。
在一项多中心研究中，对199名4至18岁儿童的行为功能和学业成绩进行了检查。64名儿童距离完成ALL（n = 28）或肾母细胞瘤（n = 36）化疗至少1年。将他们与兄弟姐妹（n = 37）以及健康学童对照组（n = 98）进行比较。
发现ALL患儿存在行为和教育问题的风险适度增加，但肾母细胞瘤患儿不存在。与同龄同龄人相比，上小学的ALL患儿学业成绩较差；然而，特殊教育服务的利用率较低。教师评定的行为和数学成绩与ALL患儿的注意力功能相关。与标准风险组相比，ALL高风险组存在过多的问题行为和学业表现不佳。在兄弟姐妹和对照组之间未发现差异。
有证据表明儿童ALL幸存者存在细微但显著的行为和教育问题，但肾母细胞瘤幸存者不存在功能障碍。仅接受化疗治疗的ALL患儿需要进行仔细的随访。
