Departmentof Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA.
Pediatr Blood Cancer. 2013 Aug;60(8):1350-7. doi: 10.1002/pbc.24496. Epub 2013 Feb 26.
Assess the intellectual and academic outcomes as well as risk factors associated with treatment for average-risk medulloblastoma in childhood using 23.4 Gy of craniospinal radiotherapy plus adjuvant chemotherapy.
From an overall sample of 379 enrolled in the parent study (COG A9961), 110 patients received a total of 192 assessments over more than 5 years with standardized IQ and academic achievement tests. Random coefficient models of the various outcomes were developed that incorporated covariates including chemotherapy regimen, age at diagnosis, sex, initial Full Scale IQ, and mutism.
Participants in this study were found to be comparable to the overall sample in all demographic, disease, and treatment factors, except there were more gross total resections in the subsample undergoing intellectual and academic assessment. Major findings include significant decline in both intellectual and academic domains over time that were greater in children who were younger at diagnosis and had higher initial intelligence test scores. Children with mutism were at higher risk for initial effects on intelligence. No effects of sex were found.
These results show progressive decline over several years post-treatment in standardized intellectual and academic scores. Despite recent improvements in therapies for these children, most notably a decrease dose of craniospinal radiation, they remain at risk. The pursuit of less toxic treatments, particularly for younger children, should continue. Neuropsychological surveillance should be routine at centers treating children with brain tumors.
评估使用 23.4Gy 颅脊髓放疗加辅助化疗治疗儿童平均风险髓母细胞瘤的智力和学业结果以及相关风险因素。
在参加母研究（COG A9961）的总共 379 名患者中，110 名患者在 5 年以上的时间内接受了总共 192 次标准化智商和学业成绩测试。开发了各种结果的随机系数模型，其中包含了化疗方案、诊断时的年龄、性别、初始全量表智商和缄默等协变量。
研究参与者在所有人口统计学、疾病和治疗因素方面与总体样本相当，除了在接受智力和学业评估的亚组中，有更多的大体全切除。主要发现包括随着时间的推移，智力和学业领域都出现了显著下降，在诊断时年龄较小和初始智力测试得分较高的儿童中更为明显。缄默的儿童智力初始受影响的风险更高。未发现性别的影响。
这些结果表明，在治疗后几年内，标准化的智力和学业成绩呈渐进性下降。尽管这些儿童的治疗方法最近有所改进，尤其是颅脊髓放疗剂量降低，但他们仍存在风险。应继续寻求毒性较小的治疗方法，特别是针对年龄较小的儿童。神经心理学监测应成为治疗脑肿瘤儿童的常规治疗。
