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Neuropsychological outcomes of patients with low-grade glioma diagnosed during the first year of life

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Abstract

Purpose

Low-grade gliomas (LGG) are a heterogeneous group of brain tumors, which are often assumed to have a benign course. Yet, children diagnosed and treated for LGG in infancy are at increased risk for neurodevelopmental disruption. We sought to investigate neuropsychological outcomes of infants diagnosed with LGG.

Methods

Between 1986 and 2013, 51 patients were diagnosed with LGG before 12 months of age and managed at St. Jude Children’s Research Hospital. Twenty-five of the 51 patients received a cognitive assessment (68% male; 6.8 ± 3.3 months at diagnosis; 10.5 ± 4.8 years at latest assessment). Approximately half the patients received radiation therapy (n = 12; aged 4.0 ± 3.0 years at radiation therapy), with a median of 2 chemotherapy regimens (range = 0–5) and 1 tumor directed surgery (range = 0–5).

Results

The analyses revealed performance below age expectations on measures of IQ, memory, reading, mathematics, and fine motor functioning as well as parent-report of attention, executive, and adaptive functioning. Following correction for multiple comparisons, a greater number of chemotherapy regimens was associated with lower scores on measures of IQ and mathematics. More tumor directed surgeries and presence of visual field loss were associated with poorer dominant hand fine motor control. Radiation therapy exposure was not associated with decline in neuropsychological performance.

Conclusions

Children diagnosed with LGG in infancy experience substantial neuropsychological deficits. Treatment factors, including number of chemotherapy regimens and tumor directed surgeries, may increase risk for neurodevelopmental disruption and need to be considered in treatment planning.

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Funding

This work was supported, in part, by the National Cancer Institute (St. Jude Cancer Center Support [CORE] Grant [P30-CA21765] and Pediatric Oncology Education Program Grant [R25CA23944]) and the American Lebanese Syrian Associated Charities (ALSAC).

Author information

Authors and Affiliations

  1. Department of Psychology, St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105-2794, USA

    Andrew M. Heitzer, Jason M. Ashford & Heather M. Conklin

  2. Pediatric Oncology Education Program, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Camden Hastings

  3. Department of Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Anthony P. Y. Liu, Mary Hoehn, Yahya Ghazwani, Amar Gajjar & Ibrahim Qaddoumi

  4. Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Shengjie Wu

  5. Rehabilitation Services, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Johnnie K. Bass

  6. Department of Ophthalmology, University of Tennessee Health Science Center, Memphis, TN, USA

    Robert Vestal & Mary Hoehn

  7. Department of Surgery, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Mary Hoehn & Frederick Boop

  8. Department of Pathology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Jason Chiang

  9. Department of Radiation Oncology, St. Jude Children’s Research Hospital, Memphis, TN, USA

    Sahaja Acharya & Thomas E. Merchant

  10. Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Frederick Boop

  11. Le Bonheur Neuroscience Institute, Le Bonheur Children’s Hospital, Memphis, TN, USA

    Frederick Boop

  12. Semmes Murphey Clinic, Memphis, TN, USA

    Frederick Boop

Authors
  1. Andrew M. Heitzer
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  12. Frederick Boop
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  13. Amar Gajjar
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  14. Thomas E. Merchant
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  15. Ibrahim Qaddoumi
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  16. Heather M. Conklin
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Corresponding author

Correspondence to Heather M. Conklin.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Due to the retrospective nature of this study, a waiver of consent was approved by the institutional IRB.

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Heitzer, A.M., Ashford, J.M., Hastings, C. et al. Neuropsychological outcomes of patients with low-grade glioma diagnosed during the first year of life. J Neurooncol 141, 413–420 (2019). https://doi.org/10.1007/s11060-018-03048-0

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  • DOI: https://doi.org/10.1007/s11060-018-03048-0

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