Jenkin D, Danjoux C, Greenberg M
Abramson Cancer Center of the University of Pennsylvania
Ultima Vez Modificado: 1 de noviembre del 2001
Reviewers: John Han-Chih Chang, MD
Source: Medical and Pediatric Oncology 1998; Volume 31: pages 506 - 511.
This article attempts to review the experience of the primary brain tumor patients treated with surgery and RT at the University of TorontoCentres. Focus was mainly on quality of life, in particular neurocognitive sequelae of treatment.
|Neurocognitive Deficit||Age less than 2 years old||Aged 2 - 4 years|
|Major Ambulation Difficulty||21%||10%|
|Major Visual Defect||35%||18%|
|Moderate to Severe Hearing Loss||11%||15%|
|In Regular School System||48%||46%|
|In Special or Blind Education||52%||51%|
Table 1 has a breakdown by age and neurocognitive deficit, which I have condensed above. Data on the 23 that had survived and were olderthan 21 yielded only 3 having acquired a university and 2 a community college degree. Fourteen had not received a "higher education." This isnot too far from the national average in Canada, which has an 11% rate of university graduates in its adult population.
Surgical/tumor complications were also seen in 28% of 93 patients currently alive. These may have had an effect on the deficits seen. Thecomplications include shunt revisions, meningitis, subdural effusions and re-exploration.
The authors state that over 80% of the adult survivors are capable of independent living. One third are able to live a normal life and compete forgainful employment at a normal level. But, nearly 40% will have some major neurocognitive deficit.
One drawback of this article and of most reviews on neurocognitive sequelae of treatment in children is the lack of standardized testing beforesurgery and/or RT. That testing could have been truly revealing as to whether the tumor, surgery or the RT was the culprit behind the deficit.On the other hand, such tests performed in younger children may be inherently inaccurate. Another criticism is that some of the data wereobtained from questionnaires and phone calls. Finally, little was made about a comparison to those with primary brain tumors who did notreceive RT. Hopefully, future and current randomized trials will answer not only OS data, but quality of life on those who do and those thatnever receive RT.
Overall, this article did suggest that not all survivors of childhood primary brain tumors perform poorly in neurocognitive functioning. Asignificant proportion can function normally in society. But, it does make us aware of the critical issue of neurologic toxicity from definitivetreatment. Limiting this morbidity without compromising survival outcome is the necessary next step.
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