Department of Psychology, The Hospital for Sick Children, Toronto, Canada.
Cancer. 2011 Dec 1;117(23):5402-11. doi: 10.1002/cncr.26127. Epub 2011 May 11.
Central nervous system germ cell tumors (CNS GCT) are typically localized to midline structures of the brain, including the pineal and suprasellar/pituitary regions. Management of these tumors depends on underlying histology (germinoma or nongerminomatous germ cell tumor). Knowledge about neurocognitive outcome in these patients is limited. Longitudinal neurocognitive outcome in CNS GCT patients seen for neuropsychological evaluation at a single institution was explored.
Thirty-five patients were seen for neurocognitive evaluation after diagnosis and treatment for a CNS GCT. Mean age at diagnosis was 11.66 years. Tumor location was suprasellar in 12 patients, pineal in 9, bifocal in 10, multifocal in 3, and thalamic in 1. Standardized cognitive tests of intelligence, receptive language, visual-motor ability, memory, and academic achievement were administered. Longitudinal and cross-sectional analyses were conducted.
Intelligence, academic functioning, and receptive vocabulary were not significantly compromised in most patients treated for CNS GCT. Working memory, information processing speed, and visual memory declined significantly over time in all patients. Patients with pineal tumors showed early and stable deficits, whereas patients with suprasellar and bifocal tumors showed more protracted declines from initial average functioning. Patients treated with ventricular versus craniospinal radiation displayed better outcome.
Although general cognitive abilities appeared stable and intact after treatment for most children with CNS GCT, a significant decline over time in working memory, processing speed, and visual memory was evident. Tumor location appeared to be important in understanding the trajectory of stability and decline in CNS GCT patients, as did radiation field.
中枢神经系统生殖细胞瘤（CNS GCT）通常局限于大脑的中线结构，包括松果体和鞍上/垂体区域。这些肿瘤的治疗取决于潜在的组织学（生殖细胞瘤或非生殖细胞瘤生殖细胞肿瘤）。关于这些患者的神经认知结果的知识有限。在单一机构进行神经心理学评估时，探讨了 CNS GCT 患者的纵向神经认知结果。
35 名患者在诊断和治疗 CNS GCT 后接受神经认知评估。诊断时的平均年龄为 11.66 岁。肿瘤位于鞍上 12 例，松果体 9 例，双焦点 10 例，多焦点 3 例，丘脑 1 例。进行了智力、接受性语言、视觉运动能力、记忆和学业成绩的标准化认知测试。进行了纵向和横向分析。
大多数接受 CNS GCT 治疗的患者的智力、学业功能和接受性词汇量没有明显受损。所有患者的工作记忆、信息处理速度和视觉记忆随时间显著下降。松果体肿瘤患者表现出早期和稳定的缺陷，而鞍上和双焦点肿瘤患者则表现出从初始平均功能开始的更持久下降。接受脑室与颅脊髓放疗的患者表现出更好的结果。
尽管大多数接受 CNS GCT 治疗的儿童的一般认知能力在治疗后似乎稳定且完整，但在工作记忆、处理速度和视觉记忆方面随时间明显下降。肿瘤位置似乎对于理解 CNS GCT 患者的稳定性和下降轨迹很重要，辐射场也是如此。
