Cognitive and Adaptive Outcome in Low-Grade Pediatric Cerebellar Astrocytomas: Evidence of Diminished Cognitive and Adaptive Functioning in National Collaborative Research Studies (CCG 9891/POG 9130) Dean W. Beebe, M. Douglas Ris, F. Daniel Armstrong, John Fontanesi, Raymond Mulhern, Emi Holmes, and Jeffrey H. Wisoff A B S T R A C T Purpose Clinicians often assume that children with posterior fossa tumors are at minimal risk for cognitive or adaptive deficits if they do not undergo cranial irradiation. However, small case series have called that assumption into question, and have also suggested that nonirradiated cerebellar tumors can cause location-specific cognitive and adaptive impairment. This study (1) assessed whether resected but not irradiated pediatric cerebellar tumors are associated with cognitive and adaptive functioning deficits, and (2) examined the effect of tumor location and medical complications on cognitive and adaptive functioning. Patients and Methods The sample was composed of 103 children aged 3 to 18 years with low-grade cerebellar astrocytomas, who underwent only surgical treatment as part of Children’s Cancer Group protocol 9891 or Pediatric Oncology Group protocol 9130. The sample was divided into three groups based on primary tumor location: vermis, left hemisphere, or right hemisphere. Data were collected prospectively on intelligence, academic achievement, adaptive skills, behav- ioral functioning, and pre-, peri-, and postsurgical medical complications. Results The sample as a whole displayed an elevated risk for cognitive and adaptive impairment that was not associated consistently with medical complications. Within this group of children with cerebellar tumors, tumor location had little effect on cognitive, adaptive, or medical outcome. Conclusion We did not replicate previous findings of location-specific effects on cognitive or adaptive outcome. However, the elevated risk of deficits in this population runs contrary to clinical lore, and suggests that clinicians should attend to the functional outcomes of children who undergo only surgical treatment for cerebellar tumors. J Clin Oncol 23:5198-5204. © 2005 by American Society of Clinical Oncology INTRODUCTION Although the cerebellum has long been known to have a role in motor coordination and timing, there is an increasing apprecia- tion of its role in higher-level cognition. Fo- cal lesions of the cerebellar hemispheres affect cognitive functions generally associ- ated with contralateral cortical tissues (eg, right cerebellar lesions affect language), and lesions of the vermis have been linked to behavioral alterations and executive dys- function similar to those produced by dis- ruption of frontal-subcortical circuits. 1-4 Furthermore, acquired and congenital cere- bellar abnormalities of childhood have been linked to a subsequent cascade of abnormal cortical development. 5,6 From the Cincinnati Children’s Hospital Medical Center and The University of Cincinnati School of Medicine, Cincinnati, OH; Mailman Center for Child Development; University of Miami School of Medicine, Miami, FL; Univer- sity of California, San Diego, San Diego, CA; St Jude’s Research Hospital, Memphis, TN; Children’s Oncology Group, Arcadia, CA; New York Univer- sity Medical Center, New York, NY. Submitted June 16, 2004; accepted March 29, 2005. Presented in part at the 2001 Spring meeting of the International Neuropsy- chological Society, Chicago, IL, February 14-17, 2001, and the 2002 Spring meeting of the International Neuropsychological Society, Toronto, Ontario, Canada, February 13-16, 2002. Participating institutions, principal inves- tigators, and grant numbers for all stud- ies in this report are listed in the Appendix. Authors’ disclosures of potential con- flicts of interest are found at the end of this article. Address reprint requests to Dean W. Beebe, Department of Psychology (MLC 3015), Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229-3039; e-mail: dean.beebe@cchmc.org, CC: dcorreia@ childrensoncologygroup.org. © 2005 by American Society of Clinical Oncology 0732-183X/05/2322-5198/$20.00 DOI: 10.1200/JCO.2005.06.117 JOURNAL OF CLINICAL ONCOLOGY O R I G I N A L R E P O R T VOLUME 23  NUMBER 22  AUGUST 1 2005 5198 Downloaded from ascopubs.org by 3.89.137.232 on June 20, 2022 from 003.089.137.232 Copyright © 2022 American Society of Clinical Oncology. All rights reserved.