National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) East of England, Cambridge, UK.
Norwich Medical School, University of East Anglia, Norwich, UK.
Int J Clin Oncol. 2020 Oct;25(10):1763-1773. doi: 10.1007/s10147-020-01725-7. Epub 2020 Jul 8.
Posterior fossa brain tumours (PFT) and their treatment in young children are often associated with subsequent cognitive impairment. However, reported follow-up periods rarely exceed 10 years. This study reports very long-term cognitive consequences of surviving an early childhood PFT.
62 adult survivors of a PFT, ascertained from a national register, diagnosed before 5 years of age, and a sibling control, received a single IQ assessment an average of 32 years (range 18-53) after initial diagnosis, using the Weschler Abbreviated Scale of Intelligence. Regression models were fitted to survivor-sibling pair differences on verbal and performance IQ (VIQ and PIQ) scores to investigate whether increasing time between PFT diagnosis and follow-up IQ assessment contributed to survivor-sibling IQ differences.
At follow-up, survivors had, on average, VIQ 15 points and PIQ 19 points lower than their siblings. There was no significant effect of time since diagnosis on survivor-sibling VIQ difference. Survivors who received radiotherapy showed no significant effect of time since diagnosis on survivor-sibling PIQ difference. Survivors who did not receive radiotherapy demonstrated a trend for it to reduce.
VIQ and PIQ deficits persist in adulthood, suggesting the effect of a fixed injury imposing on cognitive development, rather than an ongoing pathological process.
The findings will help parents and others supporting survivors of an early life PFT to identify and plan for possible cognitive outcomes, and highlight the importance of early interventions to optimize cognitive function during the developmental period.
后颅窝脑肿瘤（PFT）及其在幼儿中的治疗常与随后的认知障碍相关。然而，报告的随访期很少超过 10 年。本研究报告了儿童期后颅窝脑肿瘤幸存者非常长期的认知后果。
从国家登记处确定的 62 名 PFT 成年幸存者，在 5 岁之前被诊断出，并与一名兄弟姐妹对照，在最初诊断后平均 32 年（18-53 岁）接受了一次智商评估，使用韦氏简明智力量表。回归模型被拟合到幸存者-兄弟姐妹对言语和表现智商（VIQ 和 PIQ）分数的差异上，以研究 PFT 诊断和随访智商评估之间的时间间隔增加是否会导致幸存者-兄弟姐妹的智商差异。
在随访时，幸存者的 VIQ 平均比兄弟姐妹低 15 分，PIQ 平均低 19 分。诊断后时间对幸存者-兄弟姐妹 VIQ 差异没有显著影响。未接受放疗的幸存者在诊断后时间对幸存者-兄弟姐妹 PIQ 差异没有显著影响。接受放疗的幸存者则表现出减少的趋势。
VIQ 和 PIQ 缺陷在成年后仍然存在，这表明固定损伤对认知发展的影响，而不是持续的病理过程。
这些发现将帮助 PFT 早期生活幸存者的父母和其他支持者识别和计划可能的认知结果，并强调在发育期间进行早期干预以优化认知功能的重要性。
