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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)

From the Cincinnati Children's Hospital Medical Center and The University of Cincinnati School of Medicine, Cincinnati, OH; Mailman Center for Child Development; University of Miami School of Medicine, Miami, FL; University of California, San Diego, San Diego, CA; St Jude's Research Hospital, Memphis, TN; Children's Oncology Group, Arcadia, CA; New York University Medical Center, New York, NY

Address reprint requests to Dean W. Beebe, Department of Psychology (MLC 3015), Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; e-mail: dean.beebe{at}cchmc.org, CC: dcorreia{at}childrensoncologygroup.org

PURPOSE: Clinicians often assume that children with posterior fossa tumors are at minimal risk for cognitive or adaptive deficits if they do not undergo cranial irradiation. However, small case series have called that assumption into question, and have also suggested that nonirradiated cerebellar tumors can cause location-specific cognitive and adaptive impairment. This study (1) assessed whether resected but not irradiated pediatric cerebellar tumors are associated with cognitive and adaptive functioning deficits, and (2) examined the effect of tumor location and medical complications on cognitive and adaptive functioning.

PATIENTS AND METHODS: The sample was composed of 103 children aged 3 to 18 years with low-grade cerebellar astrocytomas, who underwent only surgical treatment as part of Children's Cancer Group protocol 9891 or Pediatric Oncology Group protocol 9130. The sample was divided into three groups based on primary tumor location: vermis, left hemisphere, or right hemisphere. Data were collected prospectively on intelligence, academic achievement, adaptive skills, behavioral functioning, and pre-, peri-, and postsurgical medical complications.

RESULTS: The sample as a whole displayed an elevated risk for cognitive and adaptive impairment that was not associated consistently with medical complications. Within this group of children with cerebellar tumors, tumor location had little effect on cognitive, adaptive, or medical outcome.

CONCLUSION: We did not replicate previous findings of location-specific effects on cognitive or adaptive outcome. However, the elevated risk of deficits in this population runs contrary to clinical lore, and suggests that clinicians should attend to the functional outcomes of children who undergo only surgical treatment for cerebellar tumors.

Presented in part at the 2001 Spring meeting of the International Neuropsychological Society, Chicago, IL, February 14-17, 2001, and the 2002 Spring meeting of the International Neuropsychological Society, Toronto, Ontario, Canada, February 13-16, 2002.

Participating institutions, principal investigators, and grant numbers for all studies in this report are listed in the Appendix.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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