Originally published as JCO Early Release 10.1200/JCO.2008.17.1371 on September 8 2008

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Cognitive and Adaptive Outcome in Extracerebellar Low-Grade Brain Tumors in Children: A Report From the Children's Oncology Group

M. Douglas Ris, Dean W. Beebe, F. Daniel Armstrong, John Fontanesi, Emi Holmes, Robert A. Sanford, Jeffrey H. Wisoff

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

Corresponding author: M. Douglas Ris, PhD, Division of Behavioral Medicine and Clinical Psychology, Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; e-mail: douglas.ris{at}cchmc.org

Purpose To determine whether pediatric patients treated with surgery only for low-grade tumors in the cerebral hemispheres, supratentorial midline, and exophytic brainstem evidence neurocognitive, academic, adaptive, or emotional/behavioral sequelae.

Patients and Methods Ninety-three patients from a natural history study of low-grade astrocytomas were tested an average of 111 days after surgery. Rates of below average ( 25th percentile) scores in this sample were compared with test norms, and performances were compared across anatomic sites. Finally, the relationships of pre-, peri-, and postsurgical complications to outcome were investigated.

Results For the entire sample, there was a significantly elevated rate of below average scores across intelligence quotient, achievement, and adaptive behavior, but not behavioral/emotional adjustment measures. Patients with hemispheric, midline, and brainstem tumors did not differ significantly. Patients with left hemisphere tumors generally performed worse than those with right hemisphere tumors. Finally, neurobehavioral outcome was unrelated to pre-, peri-, or postsurgery complications.

Conclusion After surgery for low-grade brain tumors, a significant number of patients was found to function below average, by as much as 55% compared with 25% in the normative population. Moreover, these results suggest greater risk for patients with lesions situated in the left cerebral hemisphere. Routine neuropsychological follow-up of children after treatment for low-grade tumors is recommended.

published online ahead of print at www.jco.org on September 8, 2008

Supported by Children's Oncology Group (COG) Grant No. CA 98543. A complete listing of grant support for research conducted by the Children's Cancer Group and Pediatric Oncology Group before initiation of the COG grant in 2003 is available online at http://www.childrensoncologygroup.org/admin/grantinfo.htm.

Presented in part at the 31st Annual Meeting of the International Neuropsychological Society, February 5-8, 2003, Honolulu, HI.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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