Neuropsychological status of children treated for brain tumors: A critical review and integrative analysis

Authors

  • Dr. Raymond K. Mulhern PhD,

    Corresponding author
    1. Division of Psychology and Departments of Biostatistics and Radiation Oncology, St. Jude Children's Research Hospital, and Departments of Pediatrics and Radiology, University of Tennessee College of Medicine, Memphis, Tennessee
    • Division of Psychology, St. Jude Children's Research Hospital, Memphis, TN 38101
    Search for more papers by this author
  • Janet Hancock PhD,

    1. Division of Psychology and Departments of Biostatistics and Radiation Oncology, St. Jude Children's Research Hospital, and Departments of Pediatrics and Radiology, University of Tennessee College of Medicine, Memphis, Tennessee
    Search for more papers by this author
  • Diane Fairclough DrPH,

    1. Division of Psychology and Departments of Biostatistics and Radiation Oncology, St. Jude Children's Research Hospital, and Departments of Pediatrics and Radiology, University of Tennessee College of Medicine, Memphis, Tennessee
    Search for more papers by this author
  • Larry Kun MD

    1. Division of Psychology and Departments of Biostatistics and Radiation Oncology, St. Jude Children's Research Hospital, and Departments of Pediatrics and Radiology, University of Tennessee College of Medicine, Memphis, Tennessee
    Search for more papers by this author

Abstract

The literature on the neuropsychological status of children with primary brain tumors was reviewed to identify English-language publications reporting the results of standardized, quantitative measures of patient function. The 22 studies that met these review criteria, representing 544 patients, were evaluated to assess the relationship between traditional risk factors (age at diagnosis, tumor location, radiation therapy, and time since completion of treatment), as well as subsequent intellectual development, academic achievement, psychosocial adjustment, and neuropsychological status. The impact of other potentially salient factors, such as seizures and sensory and motor deficits, was evaluated when possible. Despite inconsistent reporting of demographic and treatment-related effects across studies which precluded formal meta-analysis, we were able to confirm the primary importance of radiation therapy volume and age at treatment on IQ. No effects were detected for tumor location. Younger children treated with cranial (whole brain) irradiation showed a 14-point deficit in IQ as compared with their older counterparts. No significant differences were noted between older children receiving lòcal or cranial irradiation, although both groups had IQ levels 12–14 points lower than those not irradiated. The high-risk groups identified in this study require increased clinical surveillance. Definitive evaluation of potential risk factors for neuropsychological impairment will depend on more complete reporting of relevant patient characteristics and interinstitutional studies. © 1992 Wiley-Liss, Inc.

Ancillary