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Long-Term Neurologic and Neurosensory Sequelae in Adult Survivors of a Childhood Brain Tumor: Childhood Cancer Survivor Study

Roger J. Packer, James G. Gurney, Judy A. Punyko, Sarah S. Donaldson, Peter D. Inskip, Marilyn Stovall, Yutaka Yasui, Ann C. Mertens, Charles A. Sklar, H. Stacy Nicholson, Lonnie K. Zeltzer, Joseph P. Neglia, Leslie L. Robison

From the Departments of Neurology and Pediatrics, Center for Neuroscience and Behavioral Medicine, Children’s National Medical Center, Departments of Neurology and Pediatrics, The George Washington University, Washington, DC; Department of Pediatrics, University of Minnesota, Minneapolis, MN; Department of Radiation Oncology, Stanford University Medical Center, Stanford; Department of Pediatrics, David Gelfen School of Medicine at the University of California, Department of Pediatrics, Los Angeles, CA; Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD; Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX; Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, Seattle, WA; Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, NY; and Division of Pediatric Hematology/Oncology, Oregon Health and Science University, Portland, OR.

Address reprint requests to Roger J. Packer, MD, Department of Neurology, Children’s National Medical Center, 111 Michigan Ave NW, Washington, DC 20010; e-mail: rpacker{at}cnmc.org.

Purpose: To describe the neurologic and neurosensory deficits in children with brain tumors (BTs), compare incidence of these deficits with that of a sibling control group, and evaluate the factors associated with the development of these deficits.

Patients and Methods: Detailed questionnaires were completed on 1,607 patients diagnosed between 1970 and 1986 with a primary CNS tumor. Neurosensory and neurologic dysfunctions were assessed and results compared with those of a sibling control group. Medical records on all patients were abstracted, including radiotherapy dose and volume.

Results: Seventeen percent of patients developed neurosensory impairment. Relative to the sibling comparison group, patients surviving BTs were at elevated risk for hearing impairments (relative risk [RR], 17.3; P = < .0001), legal blindness in one or both eyes (RR, 14.8; P = < .0001), cataracts (RR, 11.9; P = < .0001), and double vision (RR, 8.8; P = < .0001). Radiation exposure greater than 50 Gy to the posterior fossa was associated with a higher likelihood of developing any hearing impairment. Coordination and motor control problems were reported in 49% and 26%, respectively, of survivors. Children receiving at least 50 Gy to the frontal brain regions had a moderately elevated risk for motor problems (RR, 2.0; P < .05). Seizure disorders were reported in 25% of patients, including 6.5% who had a late first occurrence. Radiation dose of 30 Gy or more to any cortical segment of the brain was associated with a two-fold elevated risk for a late seizure disorder.

Conclusion: Children surviving BTs are at significant risk for both early and late neurologic or neurosensory sequelae. These sequelae need to be prospectively monitored.

Supported by National Cancer Institute Grant U24 CA 55727.

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