Quality of long-term survival in young children with medulloblastoma

Restricted access

✓ The reported success of treatment for children with medulloblastoma must be balanced against the effect that treatment has on the quality of life of long-term survivors. The outcome of long-term survivors reported in previous studies has been conflicting. The authors evaluate the mental and behavioral skills of a group of medulloblastoma survivors from their institution, all of whom had survived for more than 5 years postdiagnosis. A review of the institutional records yielded 32 patients. Twenty-three families were interviewed by telephone and, of these, 13 subjects came to the hospital for detailed neuropsychological and neurological evaluations.

Intelligence quotient (IQ) was less than 90 for all participants tested, and patients diagnosed before the age of 3 years had lower IQ scores on average than those diagnosed later. Mean IQ and achievement test scores in reading, spelling, and mathematics were all higher in survivors who had undergone shunting. Achievement test results were often not in accord with intellectual potential, and individual intellectual skills varied widely. Perceptual-motor task performance was below average in more than 50% of the participants, but motor dexterity was more severely affected than perception. Problems in learning and a delay in both physical growth and development were seen in a majority of participants.

This study directs attention to the serious difficulties faced by long-term survivors of medulloblastoma and their families, and underscores the importance of routine neuropsychological testing. Moreover, the study provides further impetus to seek alternatives to irradiation in the treatment of malignant brain tumors.

Article Information

Address reprint requests to: Dennis L. Johnson, M.D., Department of Pediatric Neurosurgery, Milton S. Hershey Medical Center, P. O. Box 850, Hershey, Pennsylvania 17033.

© AANS, except where prohibited by US copyright law.



  • View in gallery

    Graph showing the distribution of Full-Scale Intelligence Quotient (IQ) scores for 13 patients with medulloblastoma who survived for at least 5 years compared with the normal distribution in the general population.



Akshoomoff NACourchesne E: A new role for the cerebellum in cognitive operations. Behav Neurosci 106:7317381992Behav Neurosci 106:


Allen JCEpstein F: Medulloblastoma and other primary malignant neuroectodermal tumors of the CNS. The effect of patients' age and extent of disease on prognosis. J Neurosurg 57:4464511982J Neurosurg 57:


Bloom HJGWallace ENKHenk JM: The treatment and prognosis of medulloblastoma in children. A study of 82 verified cases. AJR 105:43621969AJR 105:


Bordeaux JDDowell RE JrCopeland DRet al: A prospective study of neuropsychological sequelae in children with brain tumors. J Child Neurol 3:63681988J Child Neurol 3:


Chang CHHousepian EMHerbert C Jr: An operative staging system and a megavoltage radiotherapeutic technic for cerebellar medulloblastomas. Radiology 93:135113591969Radiology 93:


Chin HWMaruyama Y: Age at treatment and long-term performance results in medulloblastoma. Cancer 53:195219581984Cancer 53:


Cushing H: Experiences with the cerebellar medulloblastomas. A critical review. Acta Pathol Microbiol Scand 7:1861930Cushing H: Experiences with the cerebellar medulloblastomas. A critical review. Acta Pathol Microbiol Scand 7:


Danoff BFCowchock FSMarquette Cet al: Assessment of the long-term effects of primary radiation therapy for brain tumors in children. Cancer 49:158015861982Cancer 49:


Duffner PKCohen METhomas P: Late effects of treatment on the intelligence of children with posterior fossa tumors. Cancer 51:2332371983Cancer 51:


Ellenberg LMcComb JGSiegel SEet al: Factors affecting intellectual outcome in pediatric brain tumor patients. Neurosurgery 21:6386441987Neurosurgery 21:


Farwell JRDohrmann GJFlannery JT: Medulloblastoma in childhood: an epidemiological study. J Neurosurg 61:6576641984J Neurosurg 61:


Hirsch JFRenier DCzernichow Pet al: Medulloblastoma in childhood. Survival and functional results. Acta Neurochir 48:1151979Acta Neurochir 48:


Hoppe-Hirsch ERenier DLellouch-Tubiana Aet al: Medulloblastoma in childhood: progressive intellectual deterioration. Childs Nerv Syst 6:60651990Childs Nerv Syst 6:


Jastak JJastak S: Wide-Range Achievement Test Manual. Wilmington, Del: Jastak Associates1978Wide-Range Achievement Test Manual.


Jenkin RDT: Medulloblastoma in childhood: radiation therapy. Can Med Assoc J 100:51531969Jenkin RDT: Medulloblastoma in childhood: radiation therapy. Can Med Assoc J 100:


Kelaghan JMyers MHMulvihill JJet al: Educational achievement of long-time survivors of childhood and adolescent cancer. Med Pediatr Oncol 16:3203261988Med Pediatr Oncol 16:


Kun LEMulhern RKCrisco JJ: Quality of life in children treated for brain tumors. Intellectual, emotional, and academic function. J Neurosurg 58:161983J Neurosurg 58:


LeBaron SZeltzer PMZeltzer LKet al: Assessment of quality of survival in children with medulloblastoma and cerebellar astrocytoma. Cancer 62:121512221988Cancer 62:


Li FPWinston KRGimbrere K: Follow-up of children with brain tumors. Cancer 54:1351381984Cancer 54:


Matson DD: Neurosurgery of Infancy and Childhooded 2. Springfield, Ill: Charles C Thomas1969Matson DD:


Meadows ATMassari DJFergusson Jet al: Declines in IQ scores and cognitive dysfunctions in children with acute lymphocytic leukaemia treated with cranial irradiation. Lancet 2:101510181981Lancet 2:


Mealey JHall PV: Medulloblastoma in children. Survival and treatment. J Neurosurg 46:56641977J Neurosurg 46:


Mostow ENByrne JConnelly RRet al: Quality of life in long-term survivors of CNS tumors of childhood and adolescence. J Clin Oncol 9:5925991991J Clin Oncol 9:


Norris DGBruce DAByrd RIet al: Improved relapse-free survival in medulloblastoma utilizing modern techniques. Neurosurgery 9:6616641981Neurosurgery 9:


Nüchel BAndersen AP: Medulloblastoma. Treatment results. Acta Radiol Ther Phys Biol 17:3053111978Acta Radiol Ther Phys Biol 17:


Packer RJSposto RAtkins TEet al: Quality of life in children with primitive neuroectodermal tumors (medulloblastoma) of the posterior fossa. Pediatr Neurosci 13:1691751987Pediatr Neurosci 13:


Packer RJSutton LNAtkins TEet al: A prospective study of cognitive function in children receiving whole-brain radiotherapy and chemotherapy: 2-year results. J Neurosurg 70:7077131989J Neurosurg 70:


Park TSHoffman HJHendrich EBet al: Medulloblastoma: clinical presentation and management. Experience at the Hospital for Sick Children, Toronto, 1950–1980. J Neurosurg 58:5435521983J Neurosurg 58:


Raimondi AJTomita T: Medulloblastoma in childhood: comparative results of partial and total resection. Childs Brain 5:3103281979Childs Brain 5:


Smith RALampe IKahn EA: The prognosis of medulloblastoma in children. J Neurosurg 18:91971961J Neurosurg 18:


Spunberg JJChang CHGoldman Met al: Quality of long-term survival following irradiation for intracranial tumors in children under the age of two. Int J Radiat Oncol Biol Phys 7:7277361981Int J Radiat Oncol Biol Phys 7:


Wechsler D: Wechsler Adult Intelligence Scale-Revised. New York: The Psychological Corp1981Wechsler D: Wechsler Adult Intelligence Scale-Revised.


Wechsler D: Wechsler Intelligence Scale for Children-Revised. New York: The Psychological Corp1974Wechsler D: Wechsler Intelligence Scale for Children-Revised.




All Time Past Year Past 30 Days
Abstract Views 13 13 13
Full Text Views 65 65 23
PDF Downloads 91 91 37
EPUB Downloads 0 0 0


Google Scholar