Skip to main content Accessibility help
×
Home

Neurocognitive Late Effects of Pediatric Brain Tumors of the Posterior Fossa: A Quantitative Review

  • Kristen E. Robinson (a1), Claire E. Fraley (a1), Matthew M. Pearson (a2), John F. Kuttesch (a3) and Bruce E. Compas (a1)...

Abstract

Deficits in neurocognitive functioning are an important area of late effects in survivors of pediatric brain tumors; however, a quantitative analysis of the magnitude of these deficits in survivors of brain tumors of the posterior fossa has not been conducted. Despite tumor locations in the posterior regions of the brain, individual studies have documented deficits in a variety of domains, reflective of impairment in other brain regions. The current study provides a comprehensive meta-analysis of literature on neurocognitive late effects found in survivors of posterior fossa tumors. Results indicated significant deficits in both specific and broad indices of neurocognitive functioning, and the overall magnitude of effects across domains ranged from medium to large (g = −0.62 to −1.69) with a large mean overall effect size (g = −1.03). Moderator analyses indicated significantly greater effects for survivors diagnosed at a younger age and those who received radiation therapy. These findings underscore the importance of monitoring neurocognitive late effects in survivors of pediatric brain tumors of the posterior fossa, as well as the need for more consistent consideration of demographic, diagnostic, and treatment-related variables to allow for examination of factors that moderate these deficits. (JINS, 2012, 19, 1–10)

Copyright

Corresponding author

Correspondence and reprint requests to: Kristen E. Robinson, Department of Psychology & Human Development, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203. E-mail: kristen.e.robinson@vanderbilt.edu

References

Hide All
Aarsen, F.K., Van Dongen, H.R., Paquier, P.F., Van Mourik, M., Catsman-Berrevoets, C.E. (2004). Long-term sequelae in children after cerebellar astrocytoma surgery. Neurology, 62, 13111316. doi:10.1212/01.WNL.0000120549.77188.38
Alexander, E., Loeffler, J.S. (1999). The case for radiosurgery. Clinical Neurosurgery, 45, 3240.
Ater, J.L., Moore, B.D., Francis, D.J., Castillo, R., Slopis, J., Copeland, D.R. (1996). Correlation of medical and neurosurgical events with neuropsychological status in children at diagnosis of astrocytoma: Utilization of a neurological severity score. Journal of Child Neurology, 11, 462469.
Beebe, D.W., Ris, M.D., Armstrong, F.D., Fontanesi, J., Mulhern, R.K., Holmes, E., Wisoff, J.H. (2005). Cognitive and adaptive outcome in low-grade pediatric cerebellar astrocytomas: Evidence of diminished cognitive and adaptive functioning in national collaborative research studies (CCG 9891/POG 9130). Journal of Clinical Oncology, 23, 51985204. doi:10.1200/JCO.2005.06.117
Benesch, M., Spiegl, K., Winter, A., Passini, A., Lackner, H., Moser, A., Urban, C. (2009). A scoring system to quantify late effects in children after treatment for medulloblastoma/ependymoma and its correlation with quality of life and neurocognitive functioning. Child's Nervous System, 25, 173181. doi:10.1007/s00381-008-0742-1
Bonner, M.J., Hardy, K.K., Willard, V.W., Anthony, K.K., Hood, M., Gururangan, S. (2008). Social functioning and facial expression recognition in survivors of pediatric brain tumors. Journal of Pediatric Psychology, 33, 11421152. doi:10.1093/jpepsy/jsn035
Borenstein, M., Rothstein, H. (2005). Comprehensive meta-analysis computer program and manual. Englewood Cliffs, NJ: Biostat, Inc.
Callu, D., Viguier, D., Laroussinie, F., Puget, S., Boddaert, N., Kieffer, V., Dellatolas, G. (2009). Cognitive and academic outcome alter benign or malignant cerebellar tumor in children. Cognitive and Behavioral Neurology, 22, 270278. doi:10.1097/WNN.0b013e3181bf2d4c
Central Brain Tumor Registry of the United States (2008). Statistical report: Primary brain tumors in the United States, 2000–2004. Hinsdale, IL: the Central Brain Tumor Registry of the United States.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
Copeland, D.R., deMoor, C., Moore, B.D., Ater, J.L. (1999). Neurocognitive development of children after a cerebellar tumor in infancy: A longitudinal study. Journal of Clinical Oncology, 17, 34763486. doi:0732-183X/99/1711-3476
Dennis, M., Spiegler, B.J., Hetherington, C.R., Greenberg, M.L. (1996). Neuropsychological sequelae of the treatment of children with medulloblastoma. Journal of Neurooncology, 29, 91101. doi:10.1007/BF00165522
Docking, K.M., Ward, E.C., Murdoch, B.E. (2005). Language outcomes subsequent to treatment of brainstem tumour in childhood. Neurorehabilitation, 20, 107124. doi:1053-8135/05
Duffner, P.K., Cohen, M.E., Thomas, P. (1983). Late effects of treatment on the intelligence of children with posterior fossa tumors. Cancer, 51, 233237. doi:0008-543X/83/0115/0233
El-Ghandour, N.M. (2011). Endoscopic third ventriculostomy versus ventriculoperitoneal shunt in the treatment of obstructive hydrocephalus due to posterior fossa tumors in children. Child's Nervous System, 27, 117126.
Fuemmeler, B.F., Elkin, T.D., Mullins, L.L. (2002). Survivors of childhood brain tumors: Behavioral, emotional, and social adjustment. Clinical Psychology Review, 22, 547585.
George, A.P., Kuehn, S.M., Vassilyadi, M., Richards, P.M.P., Parlow, S.E., Keene, D.L., Ventureyra, E.C.G. (2003). Cognitive sequelae in children with posterior fossa tumors. Pediatric Neurology, 28, 4247. doi:10.1016/S0887-8994(02)00471-X
Goldwein, J.W., Radcliffe, J., Johnson, J., Moshang, T., Packer, R.J., Sutton, L.N., D'Angio, G.J. (1996). Updated results of a pilot study of low dose craniospinal irradiation plus chemotherapy for children under five with cerebellar primitive neuroectodermal tumors (medulloblastoma). International Journal of Radiation Oncology, Biology, Physics, 14, 899904.
Grill, J., Renaux, V.K., Bulteau, C., Viguier, D., Levy-Piebois, C., Sainte-Rose, C., Kalifa, C. (1999). Long-term intellectual outcome in children with posterior fossa tumors according to radiation doses and volumes. International Journal of Radiation Oncology Biology and Physics, 45, 137145. doi:S0360-3016/99/00177-7
Gurney, J.G., Kadan-Lottick, N.S., Packer, R.J., Neglia, J.P., Sklar, C.A., Punyko, J.A., Robison, L.L. (2003). Endocrine and cardiovascular late effects among adult survivors of childhood brain tumors. Cancer, 97, 663673. doi:10.1002/cncr.11095
Hardy, K.K., Bonner, M.J., Willard, V.W., Watral, M.A., Gururangan, S. (2008). Hydrocephalus as a possible additional contributor to cognitive outcome in survivors of pediatric medulloblastoma. Psychooncology, 17, 11571161. doi:10.1002/pon.1349
Hetherington, R., Dennis, M., Spiegler, B. (2000). Perception and estimation of time in long-term survivors of childhood posterior fossa tumors. Journal of the International Neuropsychological Society, 6, 682692.
Holmquist, L.A., Scott, J. (2002). Treatment, age, and time-related predictors of behavioral outcome in pediatric brain tumor survivors. Journal of Clinical Psychology in Medical Settings, 9, 315321. doi:10.1023/A:1020791018897
Howlader, N., Noone, A.M., Krapcho, M., Neyman, N., Aminou, R., Waldron, W., Edwards, B.K. (Eds.). (2011). SEER cancer statistics review, 1975–2008. Bethesda, MD: National Cancer Institute.
Jain, N., Krull, K.R., Brouwers, P., Chintagumpala, M.M., Woo, S.Y. (2008). Neuropsychological outcome following intensity-modulated radiation therapy for pediatric medulloblastoma. Pediatric Blood and Cancer, 51, 275279. doi:10.1002/pbc.21590
Kao, G.D., Goldwein, J.W., Schultz, D.J., Radcliffe, J., Sutton, L., Lange, B. (1994). The impact of perioperative factors on subsequent intelligence quotient deficits in children treated for medulloblastoma/posterior fossa primitive neuroectodermal tumors. Cancer, 74, 965971.
Karatekin, C., Lazareff, J.A., Asarnow, R.F. (2000). Relevance of the cerebellar hemispheres for executive functions. Pediatric Neurology, 22, 106112. doi:10.1016/S0887-8994(99)00128-9
Kieffer-Renauz, V., Bulteau, C., Grill, J., Kalifa, C., Viguier, D., Jambaque, I. (2000). Patterns of neuropsychological deficits in children with medulloblastoma according to craniospinal irradiation doses. Developmental Medicine and Child Neurology, 42, 741745. doi:10.1111/j.1469-8749.2000.tb00036.x
King, T.Z., Fennell, E.B., Williams, L., Algina, J., Boggs, S., Crosson, B., Leonard, C. (2004). Verbal memory abilities in children with brain tumors. Child Neuropsychology, 10, 7688. doi:10.1080/09297040490911096
Levisohn, L., Cronin-Golomb, A., Schmahmann, J.D. (2000). Neuropsychological consequences of cerebellar tumour resection in children: Cerebellar cognitive affective syndrome in a paediatric population. Brain, 123, 10411050. doi:10.1093/brain/123.5.1041
Lipsey, M.W., Wilson, D.B. (2000). Practical meta-analysis. Thousand Oaks: SAGE Publications.
Mabbott, D.J., Penkman, L., Witol, A., Strother, D., Bouffet, E. (2008). Core neurocognitive functions in children treated for posterior fossa tumors. Neuropsychology, 22, 159168. doi:10.1037/0894-4105.22.2.159
Maddrey, A.M., Bergeron, J.A., Lombardo, E.R., McDonald, N.K., Mulne, A.F., Barenberg, P.D., Bowers, D.C. (2005). Neuropsychological performance and quality of life of 10 year survivors of childhood medulloblastoma. Journal of Neurooncology, 72, 245253. doi:10.1007/s11060-004-3009-z
Merchant, T.E., Pollack, I.F., Loeffler, J.S. (2010). Brain tumors across the age spectrum: Biology, therapy and late effects. Seminars in Radiation Oncology, 20, 5866. doi:10.1016/j.semradonc.2009.09.005
Moore, B.D., Ater, J.L., Copeland, D.R. (1992). Improved neuropsychological outcome in children with brain tumors diagnosed during infancy and treated without cranial irradiation. Journal of Child Neurology, 7, 281290. doi:10.1177/088307389200700308
Mulhern, R.K., Butler, R.W. (2004). Neurocognitive sequelae of childhood cancers and their treatment. Pediatric Rehabilitation, 7, 114. doi:10.1080/13638490310001655528
Mulhern, R.K., Hancock, J., Fairclough, D., Kun, L. (1992). Neuropsychological status of children treated for brain tumors: A critical review and integrative analysis. Medical and Pediatric Oncology, 20, 181191. doi:10.1002/mpo.2950200302
Mulhern, R.K., Kepner, J.L., Thomas, P.R., Armstrong, F.D., Friedman, H.S., Kun, L.E. (1998). Neuropsychologic functioning of survivors of childhood medulloblastoma randomized to receive conventional or reduced-dose craniospinal irradiation: A Pediatric Oncology Group study. Journal of Clinical Oncology, 16, 17231728. doi:0732-183X/98/1605-0041
Mulhern, R.K., Kun, L.E. (1985). Neuropsychologic function in children with brain tumors III: Interval changes in the six months following treatment. Medical and Pediatric Oncology, 13, 318324. doi:10.1002/mpo.2950130604
Mulhern, R.K., Palmer, S.L., Reddick, W.E., Glass, J.O., Kun, L.E., Taylor, J., Gajjar, A. (2001). Risk of young age for selected neurocognitive deficits in medulloblastoma are associated with white matter loss. Journal of Clinical Oncology, 19, 472479. doi:0732-183X/01/1902-472
Mulhern, R.K., Reddick, W.E., Palmer, S.L., Glass, J.O., Elkin, T.D., Kun, L.E., Gajjar, A. (1999). Neurocognitive deficits in medulloblastoma survivors and white matter loss. Annals of Neurology, 46, 834841. doi:10.1002/1531-8249(199912)46:6<834::AID-ANA5>3.0.CO;2-M
Nagel, B.J., Delis, D.C., Palmer, S.L., Reeves, C., Gajjar, A., Mulhern, R.K. (2006). Early patterns of verbal memory impairment in children treated for medulloblastoma. Neuropsychology, 20, 105122. doi:10.1037/0894-41.0.20.1.105
Nathan, P.C., Patel, S.K., Dilley, K., Goldsby, R., Harvey, J., Jacobsen, C., Armstrong, D. (2007). Guidelines for identification of, advocacy for, and interventions in neurocognitive problems in survivors of childhood cancer: A report from the Children's Oncology Group. Archives of Pediatric and Adolescent Medicine, 161, 798806.
Ness, K.K., Gurney, J.G. (2007). Adverse late effects of childhood cancer and its treatment on health and performance. Annual Review of Public Health, 28, 279302. doi:10.1146/annurev.publhealth.28.021406.144049
Palmer, S.L., Goloubeva, O., Reddick, W.E., Glass, J.O., Gajjar, A., Kun, L., Mulhern, R.K. (2001). Patterns of intellectual development among survivors of pediatric medulloblastoma: A longitudinal analysis. Journal of Clinical Oncology, 19, 23022308. doi:0732-183X/01/1908-2302
Palmer, S.L., Hassall, T., Evankovich, K., Mabbott, D.J., Bonner, M., Deluca, C., Gajjar, A. (2010). Neurocognitive outcome 12 months following cerebellar mutism syndrome in pediatric patients with medulloblastoma. Neurooncology, 12, 13111317. doi:10.1093/neuonc/noq094
Papazoglou, A., King, T.Z., Morris, R.D., Krawiecki, N.S. (2008). Cognitive predictors of adaptive functioning vary according to pediatric brain tumor location. Developmental Neuropsychology, 33, 505520. doi:10.1080/87565640802101490
Patel, S.K., Mullins, W.A., O'Neil, S.H., Wilson, K. (2011). Neuropsychological differences between survivors of supratentorial and infratentorial brain tumours. Journal of Intellectual Disabilities Research, 55, 3040. doi:10.1111/j.1365-2788.2010.01344.x
Prentice, D.A., Miller, D.T. (1992). When small effects are impressive. Psychological Bulletin, 112, 160164. doi:10.1037/0033-2909.112.1.160
Radcliffe, J., Bunin, G.R., Sutton, L.N., Goldwein, J.W., Phillips, P.C. (1994). Cognitive deficits in long-term survivors of childhood medulloblastoma and other noncortical tumors: Age-dependent effects of whole brain radiation. International Journal of Developmental Neuroscience, 12, 327334. doi:0736-5748/94
Reeves, C.B., Palmer, S.L., Reddick, W.E., Merchant, T.E., Buchanan, G.M., Gajjar, A., Mulhern, R.K. (2006). Attention and memory functioning among pediatric patients with meduloblastoma. Journal of Pediatric Psychology, 31, 272280. doi:10.1093/jpepsy/jsj019
Reimers, T.S., Ehrenfels, S., Mortensen, E.L., Schmiegelow, M., Sonderkaer, S., Carstensen, H., Muller, J. (2003). Cognitive deficits in long-term survivors of childhood brain tumors: Identification of predictive factors. Medical and Pediatric Oncology, 40, 2634. doi:10.1002/mpo.10211
Riva, D., Giorgi, C. (2000). The cerebellum contributes to higher functions during development: Evidence from a series of children surgically treated for posterior fossa tumours. Brain, 123, 10511061. doi:10.1093/brain/123.5.1051
Riva, D., Giorgi, C., Nichelli, F., Bulgheroni, S., Massimino, M., Cefalo, G., Pantaleoni, C. (2002). Intrathecal methotrexate affects cognitive function in children with medulloblastoma. Neurology, 59, 4853.
Robinson, K.E., Kuttesch, J.F., Champion, J.E., Andreotti, C.F., Hipp, D.W., Bettis, A., Compas, B.E. (2010). A quantitative meta-analysis of neurocognitive sequelae in survivors of pediatric brain tumors. Pediatric Blood and Cancer, 55, 525531. doi:10.1002/pbc.22568
Ronning, C., Sundet, K., Due-Tonnessen, B., Lundar, T., Helseth, E. (2005). Persistent cognitive dysfunction secondary to cerebellar injury in patients treated for posterior fossa tumors in childhood. Pediatric Neurosurgery, 41, 521. doi:10.1159/000084860
Rosenthal, R. (1991). Meta-analysis procedures for social research: Applied social research methods series, Vol. 6. Beverly Hills: Sage Publication.
Scott, R.B., Stoodley, C.J., Anslow, P., Paul, C., Stein, J.F., Sugden, E.M., Mitchell, C.D. (2001). Lateralized cognitive deficits in children following cerebellar lesions. Developmental Medicine and Child Neurology, 43, 685691. doi:10.1017/S0012162201001232
Shadish, W.R., Haddock, C.K. (1994). Combining estimates of effect size. In H. Cooper & L.V. Hedges, (Eds.), The handbook of research synthesis (pp. 261281). New York, NY: Russell Sage Foundation.
Silber, J.H., Radcliffe, J., Peckham, V., Perilongo, G., Kishnani, P., Fridman, M., Meadows, A.T. (1992). Whole-brain irradiation and decline in intelligence: The influence of dose and age on IQ score. Journal of Clinical Oncology, 10, 13901396. doi:0732-183X/92/1009-0005
Stargatt, R., Rosenfeld, J.V., Maixner, W., Ashley, D. (2007). Multiple factors contribute to neuropsychological outcome in children with posterior fossa tumors. Developmental Neuropsychology, 32, 720748. doi:10.1080/87565640701376151
Steinlin, M., Imfeld, S., Zulauf, P., Boltshauser, E., Lovblad, K., Luthy, A.R., Kaufmann, F. (2003). Neuropsychological long-term sequelae after posterior fossa tumour resection during childhood. Brain, 126, 19982008. doi:10.1093/brain/awg195
Yang, T., Wong, T., Cheng, L., Chang, T., Hsu, T., Chen, S., Chuang, T. (1997). Neuropsychological sequelae after treatment for medulloblastoma in childhood: The Taiwan experience. Child's Nervous System, 13, 7780. doi:10.1007/s003810050046
Zebrack, B.J., Gurney, J.G., Oeffinger, K., Whitton, J., Packer, R.J., Mertens, A., Zeltzer, L.K. (2004). Psychological outcomes in long-term survivors of childhood brain cancer: A report from the Childhood Cancer Survivor Study. Journal of Clinical Oncology, 22, 9991006.

Keywords

Neurocognitive Late Effects of Pediatric Brain Tumors of the Posterior Fossa: A Quantitative Review

  • Kristen E. Robinson (a1), Claire E. Fraley (a1), Matthew M. Pearson (a2), John F. Kuttesch (a3) and Bruce E. Compas (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed