Neuropsychological Outcomes of Patients with Low-Grade Glioma Brain Tumors Diagnosed During the First Year of Life

Abstract

Objective: Low-grade gliomas (LGG) are a heterogeneous group of tumors comprising approximately 40% of central nervous system tumors in children. They are frequently assumed to have a benign course; however, children diagnosed and treated at a young age are at increased risk for neurodevelopmental disruption. Participants and Methods: Retrospective review revealed 51 patients with LGG diagnosed before 12 months of age managed at St. Jude Children’s Research Hospital from 1986-2013. 25 of the 51 patients received a cognitive assessment (68% male; 6.8 ± 3.3 months at diagnosis; 10.5 ± 4.8 years at latest cognitive assessment). Most tumors were supratentorial (N=21). Approximately half the sample received radiation therapy (N=12; 4.0 + 3.0 years at radiation exposure), with an average of 1.7 chemotherapy regimens and 1.4 tumor directed surgeries. Results: Chi-square analyses revealed performance below age expectations on measures of IQ, verbal memory, reading, mathematics, and bilateral fine motor functioning as well as parent-report of attention, executive, and adaptive functioning (ps<0.05). Parent-report of externalizing and internalizing behaviors as well as behavioral regulation were within age expectations. Children with supratentorial tumors had lower IQ scores and were rated by their parents as having greater adaptive skill deficits (ps<0.05). Greater number of chemotherapy regimens was associated with lower scores on measures of IQ, reading, mathematics, and adaptive functioning (ps<0.05). More tumor directed surgeries was associated with poorer performance on measures of mathematics and dominant hand fine motor control (ps<0.05). Radiation therapy exposure had no impact on neuropsychological performance but was associated with parent report of attention problems. Conclusions: Children diagnosed with LGG in their first year of life experience a multitude of neuropsychological deficits. Identified risk factors (e.g., tumor location and treatment approach) may be useful in treatment planning and caregiver education.