Mulhern R K, Heideman R L, Khatib Z A, Kovnar E H, Sanford R A, Kun L E
Division of Psychology, St. Jude Children's Research Hospital, Memphis, TN 38101-0318.
Pediatr Neurosurg. 1994;20(4):226-32. doi: 10.1159/000120795.
In order to describe the status of long-term survivors of brain stem glioma, neuropsychological and behavioral measures were obtained a median of 2.5 (range 1.5-5.6) years after diagnosis from 16 survivors of 51 consecutively diagnosed children with brain stem glioma between 1983 and 1991. Among 11 children with dorsally exophytic tumors, 7 were treated with surgery alone (SRG) and 4 received conventionally fractionated local cranial radiation therapy (CFRT; 54-56 Gy) to the brain stem following surgery, 3 of these because of recurrent disease. Five others with diffusely infiltrative brain stem tumors received hyperfractionated radiation therapy (HFRT; 70.2 Gy) to the brain stem; 4 following biopsy or limited resection and 1 without prior surgery. IQs of children in the CFRT (mean 89, SD 24.4) and HFRT (mean 85, SD 12.7) groups were not significantly different. Children in the SRG group had significantly higher IQs (mean 100, SD 11.0) and fewer neurologic deficits than those who had received CFRT or HFRT. However, after statistically controlling for severity of neurologic deficits, treatment had no effect on IQ. The severity of residual neurologic deficits accounted for 42% of the variance in IQ scores; children with fewer neurologic problems scored higher. Additional studies are required to evaluate the potential neuropsychological benefits of equivalent total doses of HFRT compared to CFRT.
为描述脑干胶质瘤长期存活者的状况，对1983年至1991年间连续诊断的51例儿童脑干胶质瘤患者中的16例存活者在诊断后中位2.5年（范围1.5 - 5.6年）进行了神经心理学和行为测量。在11例背侧外生性肿瘤患儿中，7例仅接受了手术治疗（单纯手术组），4例在手术后接受了常规分割局部颅部放射治疗（CFRT；54 - 56 Gy）至脑干，其中3例是因为疾病复发。另外5例弥漫性浸润性脑干肿瘤患儿接受了超分割放射治疗（HFRT；70.2 Gy）至脑干；4例在活检或有限切除后接受治疗，1例未接受过手术。CFRT组（平均89，标准差24.4）和HFRT组（平均85，标准差12.7）患儿的智商无显著差异。单纯手术组患儿的智商显著更高（平均100，标准差11.0），且神经功能缺损比接受CFRT或HFRT的患儿更少。然而，在对神经功能缺损的严重程度进行统计学控制后，治疗对智商没有影响。残留神经功能缺损的严重程度占智商分数方差的42%；神经问题较少的患儿得分更高。需要进一步研究来评估与CFRT相比，等量总剂量HFRT的潜在神经心理学益处。
