Purpose of the Study The survival rate of central nervous system (CNS) tumors is increasing, but more side effects are recognized in survivors, as a result of tumor, chemo-, and radiotherapy given as treatment. We performed a retrospective analysis of cases identified as having brain tumors with survival for at least 5 years. We analyzed the charts to determine the frequency of late effects in those children who had survived their initial disease.
Methods Used 296 children, diagnosed with CNS tumors from 1986 to the present, were identified; 225 patients were eligible for inclusion in the analysis. Patients with spinal cord tumors, lymphomas, and germinomas were excluded. There were 69 patients with 5+ years survival. Data were not available for 16 patients, leaving 53 patients for analysis. Cases were then restricted to those with astrocytoma, medulloblastoma, and ependymoma, leaving 42 patients for final analysis.
Summary of Results There were 21 astrocytoma, 16 medulloblastoma, and 5 ependymoma patients. Among our patients, 71%. The problems identified included brain necrosis (5%), atrophy (12%), encephalopathy (5%), seizures (4%), hearing loss (16%), visual defect (9%), linear growth defect (1%), growth hormone deficiency (5%), sexual maturational delay (8%), intellectual/motor problems (33%), and behavioral problems (2%). The majority of side effects were seen in those individuals who received a combination of chemotherapy and radiation therapy; side effects were also more common after medulloblastoma. Among individuals receiving radiation only, necrosis was a more common effect, as was cerebral atrophy. In those having chemotherapy only, encephalopathy was more commonly seen than in those receiving radiation alone. Patients undergoing only surgery had a tendency to develop visual defects, and seizures were present in these individuals to the same extent as those receiving combination therapy. Among those with combination treatment, hearing loss was significant, as was atrophy and necrosis of the brain, and visual defect. Intellectual impairment was seen in all treatment groups but especially in those receiving chemotherapy and radiation combined. Combination therapy also resulted in the greatest degree of hormonal defects.
Conclusion Late effects can be associated with increased morbidity and impaired quality of life. Combination therapy, although improving survival, can be associated with significant long-term complications.
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