%0 Journal Article
%T Neurocognitive outcomes and functional independence in adult survivors of childhood medulloblastoma diagnosed over three decades.
%A Papini C
%A Mirzaei S S
%A Xing M
%A Tonning Olsson I
%A Salloum R
%A de Blank PMK
%A Lange KR
%A King TZ
%A Srivastava D
%A Leisenring WM
%A Howell RM
%A Oeffinger KC
%A Robison LL
%A Armstrong GT
%A Krull KR
%A Brinkman TM
%J Neuro Oncol
%V 0
%N 0
%D 2024 Jul 4
%M 38963825
%F 13.029
%R 10.1093/neuonc/noae119
%X <B>BACKGROUND: </B>Treatment of childhood medulloblastoma has evolved to reduce neurotoxicity while improving survival. However, the impact of evolving therapies on late neurocognitive outcomes and adult functional independence remains unknown.<BR><B>METHODS: </B>Adult survivors of childhood medulloblastoma (n=505; median[minimum-maximum] age, 29[18-46] years) and sibling controls (n=727; 32[18-58] years) from the Childhood Cancer Survivor Study completed surveys assessing neurocognitive problems and chronic health conditions (CHCs). Treatment exposures were categorized as historical (craniospinal irradiation [CSI]≥30 Gy, no chemotherapy), standard-risk (CSI>0 to <30 Gy +chemotherapy) and high-risk (CSI≥30 Gy +chemotherapy) therapy. Latent class analysis identified patterns of functional independence using employment, independent living, assistance with routine/personal care needs, driver's license, marital/partner status. Multivariable models estimated risk of neurocognitive impairment in survivors versus siblings and by treatment exposure group, and associations between neurocognitive impairment, CHCs, and functional independence.<BR><B>RESULTS: </B>Survivors in each treatment exposure group had 4- to 5-fold elevated risk of impaired memory and task efficiency compared to siblings. Contemporary risk-based therapies did not confer lower risk compared to historical therapy. Survivors treated in the 1990s had higher risk of memory impairment (relative risk [RR] 2.24, 95% confidence interval [CI] 1.39-3.60) compared to survivors treated in the 1970s. Sensorimotor, hearing problems and seizures were associated with 33%-34%, 25-26% and 21%-42% elevated risk of task efficiency and memory impairment, respectively. Treatment-related CHCs and neurocognitive impairment were associated with non-independence.<BR><B>CONCLUSIONS: </B>Despite treatment changes, long-term survivors of childhood medulloblastoma remain at risk for neurocognitive impairment, which was associated with CHCs. Neurocognitive surveillance after contemporary regimens is imperative.