Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: A report from the Childhood Cancer Survivor Study

Allison A. King, Kristy Seidel, Chongzhi Di, Wendy M. Leisenring, Stephanie Mabry Perkins, Kevin R. Krull, Charles A. Sklar, Daniel M. Green, Gregory T. Armstrong, Lonnie K. Zeltzer, Elizabeth Wells, Marilyn Stovall, Nicole J. Ullrich, Kevin C. Oeffinger, Leslie L. Robison, Roger J. Packer

Research output: Contribution to journalArticlepeer-review

62 Scopus citations

Abstract

Background. Medulloblastoma is the most common malignant childhood brain tumor, although long-term risks for chronic neurologic health and psychosocial functioning in aging adult survivors are incompletely characterized. Methods. The Childhood Cancer Survivor Study (CCSS) includes 380 fve-year survivors of medulloblastoma/primitive neuroectodermal tumor (PNET; median age at follow-up: 30 y, interquartile range 24-36) and sibling comparison (n = 4031). Cumulative incidence of neurologic health conditions was reported. Cox regression models provided hazard ratios (HRs) and 95% CIs. Cross-sectional outcomes were assessed using generalized linear models. Results. Compared with siblings, survivors were at increased risk of late-onset hearing loss (HR: 36.0, 95% CI: 23.6-54.9), stroke (HR: 33.9, 95% CI: 17.8-64.7), seizure (HR: 12.8, 95% CI: 9.0-18.1), poor balance (HR: 10.4, 95% CI: 6.7-15.9), tinnitus (HR: 4.8, 95% CI: 3.5-6.8), and cataracts (HR: 31.8, 95% CI: 16.7-60.5). Temporal/frontal lobe radiotherapy of 50 Gy or more increased risk for hearing loss (HR: 1.9, 95% CI: 1.1-1.3), seizure (HR: 2.1, 95% CI: 1.1-3.9), stroke (HR: 3.5, 95% CI: 1.3-9.1), and tinnitus (HR: 2.0, 95% CI: 1.0-3.9). Survivors were less likely than siblings to earn a college degree (relative risk [RR]: 0.49, 95% CI: 0.39-0.60), marry (RR: 0.35, 95% CI: 0.29-0.42), and live independently (RR: 0.58, 95% CI: 0.52-0.66). Conclusions. Adult survivors of childhood medulloblastoma/PNET demonstrate pronounced risk for hearing impairment, stroke, lower educational attainment, and social independence. Interventions to support survivors should be a high priority.

Original languageEnglish
Pages (from-to)689-698
Number of pages10
JournalNeuro-oncology
Volume19
Issue number5
DOIs
StatePublished - May 1 2017

Keywords

  • Late effects
  • Medulloblastoma
  • Neurologic outcomes
  • Psychosocial outcomes

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