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Child's Nervous System
Published in: Child's Nervous System 2/2024

12-09-2023 | Medulloblastoma | Original Article

Late effects of medulloblastoma treatment: multidisciplinary approach of survivors

Authors: Elif Habibe Aktekin, Meryem Özlem Kütük, Özlem Sangün, Nalan Yazıcı, Fatma Çaylaklı, İlknur Erol, Faik Sarıalioğlu

Published in: Child's Nervous System | Issue 2/2024

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Abstract

Purpose

Medulloblastoma is one of the brain tumors with increased life expectancy due to improvements in treatment approaches. Besides the promising results, various undesirable effects can be encountered. This study’s aim is to review long-term follow-up outcomes of our cases with medulloblastoma.

Methods

Age at diagnosis, histological type of medulloblastoma, resection extension, chemotherapy and radiotherapy schemes, follow-up duration, and endocrinological, neuropsychiatric, cardiological, auditory, and visual examination results were evaluated in 20 patients diagnosed between 2007 and 2018 and followed 5 years and more.

Results

Twenty of 53 patients were included to the study. Eleven (55%) were male. Mean age at diagnosis was 6.95 years; mean age at the time of the study was 14 years. Mean follow-up time was 8.95 years. In terms of surgery, 14 (70%) were gross total, 1 (5%) was near total, and 2 (10%) were subtotal resection. In histopathological examination, 14 (70%) were classical medulloblastoma, 4 (20%) were desmoplastic medulloblastoma, and 1 (5%) was anaplastic medulloblastoma. With regard to endocrinological evaluation, 15 (75%) patients had hypothyroidism, 5 (25%) had growth hormone deficiency, 7 (35%) had clinical growth hormone deficiency, and 5 (25%) had sex hormone disorders. In neuropsychiatric examination, 11 (55%) patients had neurological sequelae, 18 (90%) patients had psychiatric issues, and 14 (70%) patients had two or more neuropsychiatric problems simultaneously. One (5%) patient had mitral valve insufficiency. Twelve patients (60%) had hearing loss. According to visual examination, 6 (30%) patients had refraction problem, 4 (20%) had cataract, and 1 (5%) had dry eye.

Conclusion

Careful monitoring of long-term side effects is important for improving the quality of life of medulloblastoma patients. Besides endocrinological and other somatic sequelae of the disease and treatment, increased neuropsychiatric problems showed us that only cure is not the issue while treating childhood medulloblastoma.
Literature
1.
2.
Fossati P, Ricardi U, Orecchia R (2009) Pediatric medulloblastoma: toxicity of current treatment and potential role of proton-therapy. Cancer Treat Rev 35(1):79–96CrossRefPubMed
3.
Christopherson KM, Rotondo RL, Bradley JA, Pincus DW, Wynn TT et al (2014) Late toxicity following craniospinal radiation for early-stage medulloblastoma. Acta Oncol 53(4):471–80CrossRefPubMed
4.
Demir K, Özen S, Konakçı E, Aydın M, Darendeliler F (2017) A comprehensive online calculator for pediatric endocrinologists: ÇEDD Çözüm/TPEDS Metrics. J Clin Res Pediatr Endocrinol 9(2):182–184CrossRefPubMedPubMedCentral
5.
Neyzi O, Bundak R, Gökçay G, Günöz H, Furman A, Darendeliler F et al (2015) Reference values for weight, height, head circumference and body mass index in Turkish children. J Clin Res Pediatr Endocrinol 7(4):280–293CrossRefPubMedPubMedCentral
6.
7.
8.
9.
Greulich WW, Pyle SI (1959) Radiograph atlas of skeletal development of the hand and wrist, 2nd edn. Stanford University Press, California
10.
DSM-IV (1994) Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association
11.
Savaşır I, Şahin N (1995) Wechsler çocuklar için zeka ölçeği (WISCR) el kitabı. Ankara: Türk Psikologlar Derneği Yayınları
12.
Berger I, Goldzweig G (2010) Objective measures of attention-deficit/ hyperactivity disorder: a pilot study. Isr Med Assoc J 12(9):531–535PubMed
13.
Bass JK, Huang J, Onar-Thomas A, Chang KW, Bhagat SP, Chintagumpala M et al (2014) Concordance between the Chang and the International Society of Pediatric Oncology (SIOP) ototoxicity grading scales in patients treated with cisplatin for medulloblastoma. Pediatr Blood Cancer 61(4):601–605CrossRefPubMed
14.
Bernier V, Klein O (2021) Late effects of craniospinal irradiation for medulloblastomas in paediatric patients. Neurochirurgie 67(1):83–86CrossRefPubMed
15.
16.
17.
Uday S, Murray RD, Picton S, Chumas P, Raju M, Chandwani M et al (2015) Endocrine sequaelae beyond 10 years in survivors of medulloblastoma. Clin Endocrinol (Oxf) 83(5):663–670CrossRefPubMed
18.
Santos ADH, Alemany MCM, Macian FM, Carinena SL, Ballesteros EC, Nieto AC (2019) Endocrinological late effects of oncologic treatment on survivors of medulloblastoma. Rev Chil Pediatr 90(6):598–605
19.
Lauro C, Macy ME, Zeitler P, Backus J, Mettler P, Foreman N et al (2014) The relationship between thyroid dose and diagnosis of primary hypothyroidism in pediatric brain tumor patients receiving craniospinal irradiation. J Pediatr Endocrinol Metab 27(3–4):299–303PubMedPubMedCentral
20.
Quik EH, Valk GD, Drent ML, Stalpers LJA, Kenemans JL, Koppeschaar HPF et al (2012) Reduced growth hormone secretion contributes after cranial irradiation contributes to neurocognitive dysfunction. Growth Horm IGF Res 22(1):42–47CrossRefPubMed
21.
Indini A, Schiavello E, Biassoni V, Bergamaschi L, Magni MC, Puma N et al (2017) Long-term safety of growth hormone replacement therapy after childhood medulloblastoma and PNET: it is time to set aside old concerns. J Neurooncol 131(2):349–357CrossRefPubMed
22.
DeWire M, Green DM, Sklar CA, Merchant TE, Wallace D, Lin T et al (2015) Pubertal development and primary ovarian insufficiency in female survivors of embryonal brain tumors following risk-adapted craniospinal irradiation and adjuvant chemotherapy. Pediatr Blood Cancer 62(2):329–334CrossRefPubMed
23.
van Atteveld JE, Mulder RL, van den Heuvel-Eibrink MM, Hudson MM, Kremer LCM, Skinner R et al (2021) Bone mineral density surveillance for childhood, adolescent, and young adult cancer survivors: evidence-based recommendations from the International Late Effects of Childhood Cancer Guideline Harmonization Group. Lancet Diabetes Endocrinol 9(9):622–637CrossRefPubMedPubMedCentral
24.
25.
Conklin HM, Ogg RJ, Ashford JM, Scoggins MA, Zou P, Clark KN et al (2015) Computerized cognitive training for amelioration of cognitive lat effects among childhood cancer survivors: a randomised controlled trial. J Clin Oncol 33(33):3894–3902CrossRefPubMedPubMedCentral
26.
Poggi G, Liscio M, Galbiati S, Adduci A, Massimino M, Gandola L et al (2005) Brain tumors in children and adolescents: cognitive and psychological disorders at different ages. Psychooncology 14(5):386–395CrossRefPubMed
27.
Mabbott DJ, Spiegler BJ, Greenberg ML, Rutka JT, Hyder DJ, Bouffet E (2005) Serial evaluation of academic and behavioral outcome after treatment with cranial radiation in childhood. J Clin Oncol 23(10):2256–2263CrossRefPubMed
28.
Wolfe-Christensen C, Mullins LL, Scott JG, McNall-Knapp RY (2007) Persistent psychosocial problems in children who develop posterior fossa syndrome after medulloblastoma resection. Pediatr Blood Cancer 49(5):723–726CrossRefPubMed
29.
Mulhern RK, Palmer SL, Merchant TE, Wallace D, Kocak M, Brouwers P et al (2005) Neurocognitive consequences of risk-adapted therapy for childhood medulloblastoma. J Clin Oncol 23(24):5511–5519CrossRefPubMed
30.
Shabason EK, Brodsky C, Baran J, Isaac L, Minturn JE, Ginsberg JP et al (2019) Clinical diagnosis of attention-deficit/hyperactivity disorder in survivors of pediatric brain tumors. J Neurooncol 143(2):305–312CrossRefPubMed
31.
Hardy KK, Willard VW, Wigdor AB, Allen TM, Bonner MJ (2015) The potential utility of parent-reported attention screening in survivors of childhood cancer to identify those in need of comprehensive neuropsychological evaluation. Neurooncol Pract 2(1):32–39PubMed
32.
Hardy KK, Willard VW, Gioia A, Sharkey C, Walsh KS (2018) Attention-mediated neurocognitive profiles in survivors of pediatric brain tumors: comparison to children with neurodevelopmental ADHD. Neuro Oncol 20(5):705–715CrossRefPubMed
33.
Hanzlik E, Woodrome SE, Abdel-Baki M, Geller TJ, Elbabaa SK (2015) A systematic review of neuropsychological outcomes following posterior fossa surgery in children. Childs Nerv Syst 31(10):1869–1875CrossRefPubMed
34.
Merchant TE, Schreiber JE, Wu S, Lukose R, Xiong X, Gajjar A (2014) Critical combinations of radiation dose and volume predict intelligence quotient and academic achievement scores after craniospinal irradiation in children with medulloblastoma. Int J Radiat Oncol 90(3):554–561CrossRef
35.
Hoppe-Hirsch E, Renier D, Lellouch-Tubiana A, Sainte-Rose C, Pierre-Kahn A, Hirsch JF (1990) Medulloblastoma in childhood: progressive intellectual deterioration. Childs Nerv Syst 6:60–65CrossRefPubMed
36.
Knight KRG, Kraemer DF, Neuwelt EA (2005) Ototoxicity in children receiving platinum chemotherapy: underestimating a commonly occuring toxicity that may influence academic and social development. J Clin Oncol 23(34):8588–8596CrossRefPubMed
37.
38.
Orgel E, Jain S, Ji L, Pollick L, Si S, Finlay J et al (2012) Hearing loss among survivors of childhood brain tumors treated with an irradiation-sparing approach. Pediatr Blood Cancer 58(6):953–958CrossRefPubMed
39.
Welch GD, Lin KY, Fisher MJ, Hill-Kayser CE (2018) Cardiac toxicity after craniospinal irradiation: A late effect that may be eliminated with proton therapy. J Pediatr Hematol Oncol 40(5):e330–e333CrossRefPubMed
40.
Cassidy L, Stirling R, May K, Picton S, Doran R (2000) Ophthalmic complications of childhood medulloblastoma. Med Pediatr Oncol 34(1):43–47CrossRefPubMed
41.
Peeler CE (2017) A review of visual and oculomotor outcomes in children with posterior fossa tumors. Semin Pediatr Neurol 24(2):100–103CrossRefPubMed
42.
Cambruzzi E (2018) Medulloblastoma, WNT-activated/SHH-activated: clinical impact of molecular analysis and histogenetic evaluation. Childs Nerv Syst 34(5):809–815CrossRefPubMed
Metadata
Title
Late effects of medulloblastoma treatment: multidisciplinary approach of survivors
Authors
Elif Habibe Aktekin
Meryem Özlem Kütük
Özlem Sangün
Nalan Yazıcı
Fatma Çaylaklı
İlknur Erol
Faik Sarıalioğlu
Publication date
12-09-2023
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 2/2024
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-023-06146-1

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