© 2001 by Society
© 2001 by the Society forNeuro-Oncology
Long-term quality of life and neuropsychologic functioning for patientswith CNS germ-cell tumors: From the First International CNS Germ-Cell TumorStudy
Departments of Psychiatry (S.A.S.) and Pediatrics (S.A.S., H.L.W., J.L.F.), New York UniversitySchool of Medicine, New York, NY 10016; The Children'sHospital at Westmead and the University of Sydney, Sydney, Australia 2156(S.J.K.); Department of Preventive Medicine andCommunity Health, UMDNJ-New Jersey Medical School, Newark, NJ 07103(A.L.D.); Gutierrez Children's Hospital, Buenos Aries,Argentina 1425 (B.D.); Children's Hospital of LosAngeles, Los Angeles, CA 90027 (J.V.); StateUniversity of New York, Brooklyn, NY 11203 (C.B.); and Neurological Institute, Columbia-Presbyterian MedicalCenter, New York, NY 10032 (M.C.P.)
1 Address correspondence and reprint requests to Stephen A. Sands, New YorkUniversity, Hassenfeld Cancer Center, 317 E. 34th St., New York, NY 10016.
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Abstract |
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This study evaluated the quality of life and neuropsychologic functioningamong patients enrolled between 1989 and 1993 in the First International CNSGerm-Cell Tumor Study. Quality-of-life questionnaires (Short Form-36 or ChildHealth Questionnaire) were completed on 43 patients at median follow-up of 6.1years after diagnosis (range, 4.5-8.8 years), and intellectual and academictesting was performed on 22 patients. Psychosocial and physical functioning ofpatients aged 19 years and older at follow-up was within the average range,whereas the same functioning for patients aged 18 years and younger, asreported by their parents at follow-up, was low average and borderline,respectively. Overall psychosocial and physical health summary scores werepositively correlated with age at diagnosis for both groups combined. Thosewho received CNS radiation therapy (n = 29) reported significantlyworse physical health, but similar psychosocial health, compared with thosetreated without radiation. Neuropsychologic testing indicated full-scale andverbal IQ, reading, spelling, and math skills in the average range, andperformance IQ in the low average range. Intelligence and math skills werepositively correlated with age at diagnosis. Those with germinomassignificantly outperformed those with nongerminomatous/mixed tumors on allneuropsychological measures administered. Younger patients diagnosed with CNSgerm-cell tumors are at increased risk for psychosocial and physical problemsas well as neuropsychologic deficits. Exposure to irradiation adverselyaffects overall physical functioning, whereas tumor pathology appears to be asalient neurocognitive risk factor. Collaborative and randomized studies arerequired to further elucidate the late effects arising from factors such asage at diagnosis, tumor histology, level of irradiation therapy, andchemotherapy toxicity among these young and potentially curable patients.
Received September 27, 2000; Accepted January 30, 2001
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