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Grob ST, Miller KR, Sanford B, Donson AM, Jones K, Griesinger AM, Amani V, Foreman NK, Liu A, Handler M, Hankinson TC, Milgrom S, Levy JMM. Genetic predictors of neurocognitive outcomes in survivors of pediatric brain tumors. J Neurooncol 2023; 165:161-169. [PMID: 37878192 PMCID: PMC10638163 DOI: 10.1007/s11060-023-04472-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/27/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND Neurocognitive deficits are common in pediatric brain tumor survivors. The use of single nucleotide polymorphism (SNP) analysis in DNA repair genes may identify children treated with radiation therapy for brain tumors at increased risk for treatment toxicity and adverse neurocognitive outcomes. MATERIALS The Human 660W-Quad v1.0 DNA BeadChip analysis (Illumina) was used to evaluate 1048 SNPs from 59 DNA repair genes in 46 subjects. IQ testing was measured by the Wechsler Intelligence Scale for Children. Linear regression was used to identify the 10 SNPs with the strongest association with IQ scores while adjusting for radiation type. RESULTS The low vs high IQ patient cohorts were well matched for time from first treatment to most recent IQ, first treatment age, sex, and treatments received. 5 SNPs on 3 different genes (CYP29, XRCC1, and BRCA1) and on 3 different chromosomes (10, 19, and 17) had the strongest association with most recent IQ score that was not modified by radiation type. Furthermore, 5 SNPs on 4 different genes (WRN, NR3C1, ERCC4, RAD51L1) on 4 different chromosomes (8, 5, 16, 14) had the strongest association with change in IQ independent of radiation type, first IQ, and years between IQ measures. CONCLUSIONS SNPs offer the potential to predict adverse neurocognitive outcomes in pediatric brain tumor survivors. Our results require validation in a larger patient cohort. Improving the ability to identify children at risk of treatment related neurocognitive deficits could allow for better treatment stratification and early cognitive interventions.
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Affiliation(s)
- Sydney T Grob
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
| | - Kristen R Miller
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Bridget Sanford
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Andrew M Donson
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
| | - Kenneth Jones
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Andrea M Griesinger
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
| | - Vladimir Amani
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
| | - Nicholas K Foreman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
- Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Arthur Liu
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
- Department of Radiation Oncology, University of Colorado Anschutz, Aurora, CO, USA
| | - Michael Handler
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
- Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Todd C Hankinson
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
- Department of Neurosurgery, Children's Hospital Colorado, Aurora, CO, USA
| | - Sarah Milgrom
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA
- Department of Radiation Oncology, University of Colorado Anschutz, Aurora, CO, USA
- Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, 80045, USA
| | - Jean M Mulcahy Levy
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
- Morgan Adams Foundation Pediatric Brain Tumor Research Program, Children's Hospital Colorado, Aurora, USA.
- Department of Pharmacology, University of Colorado School of Medicine, Aurora, CO, 80045, USA.
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Grob ST, Miller KR, Sanford B, Donson AM, Jones K, Griesinger AM, Amani V, Foreman NK, Liu A, Handler M, Hankinson TC, Milgrom S, Levy JM. Genetic Predictors of Neurocognitive Outcomes in Survivors of Pediatric Brain Tumors. RESEARCH SQUARE 2023:rs.3.rs-3225952. [PMID: 37609195 PMCID: PMC10441450 DOI: 10.21203/rs.3.rs-3225952/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
Purpose Neurocognitive deficits are common in pediatric brain tumor survivors. The use of single nucleotide polymorphism (SNP) analysis in DNA repair genes may identify children treated with radiation therapy for brain tumors at increased risk for treatment toxicity and adverse neurocognitive outcomes. Methods The Human 660W-Quad v1.0 DNA BeadChip analysis (Illumina) was used to evaluate 1048 SNPs from 59 DNA repair genes in 46 subjects. IQ testing was measured by the Wechsler Intelligence Scale for Children. Linear regression was used to identify the 10 SNPs with the strongest association with IQ scores while adjusting for radiation type. Results The low vs high IQ patient cohorts were well matched for time from first treatment to most recent IQ, first treatment age, gender, and treatments received. 5 SNPs on 3 different genes (CYP29, XRCC1, and BRCA1) and on 3 different chromosomes (10, 19, and 17) had the strongest association with most recent IQ score that was not modified by radiation type. Furthermore, 5 SNPs on 4 different genes (WRN, NR3C1, ERCC4, RAD51L1) on 4 different chromosomes (8, 5, 16, 14) had the strongest association with change in IQ independent of radiation type, first IQ, and years between IQ measures. Conclusions SNP polymorphisms offer potential to predict adverse neurocognitive outcomes in pediatric brain tumor survivors. Our results require validation in a larger patient cohort. Improving the ability to identify children at risk of treatment related neurocognitive deficits could allow for better treatment stratification and early cognitive interventions.
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Chipeeva N, Deviaterikova A, Glebova E, Romanova E, Karelin A, Kasatkin V. Comparison of Neurocognitive Functioning and Fine Motor Skills in Pediatric Cancer Survivors and Healthy Children. Cancers (Basel) 2022; 14:cancers14235982. [PMID: 36497461 PMCID: PMC9738267 DOI: 10.3390/cancers14235982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/07/2022] Open
Abstract
Background: The late treatment outcomes of pediatric brain tumors and of hematopoietic and lymphoid tissue tumors are an important focus of both rehabilitation and research. Neurocognitive and motor disorders induce further learning problems impeding social-emotional adaptation throughout a whole lifespan. Core deficits in short-term and working memory, visuospatial constructional ability, verbal fluency, and fine motor skills underlie distorted intellectual and academic achievement. This study aimed to assess the individual differences in cognitive ability and fine motor skills of pediatric tumor survivors and the age-matched healthy controls. Methods: A total of 504 tumor survivors after treatment and 646 age-matched healthy controls underwent neurocognitive and fine motor assessments. Findings: The group of tumor survivors scored significantly worse in both neurocognitive and fine motor skill in compared with the healthy control group. The pediatric brain tumor survivors (PBT group) performed worse in cognitive (p < 0.001 for verbal fluency and p < 0.001 for visuospatial constructional ability) and motor tests (p < 0.001) compared to the healthy controls. Hematopoietic and Lymphoid Tissues tumors survivors (THL group) performed worse in verbal fluency (p < 0.01) and visuospatial constructional test (p < 0.001) compared to the control group. Furthermore, the PBT group had worse results in visuospatial constructional ability (p < 0.05) and fine motor (p < 0.001) ability than the THL group. Significant differences between females and males were found in fine motor test performance in the PBT group (p < 0.05), as well as in verbal fluency (p < 0.01) and visuospatial constructional ability (p < 0.01) in the control group. Neurocognitive and fine motor skill characteristics in the THL group did not correlate with age.
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Affiliation(s)
- Nadezda Chipeeva
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Correspondence: ; Tel.: +7-950-737-08-43
| | - Alena Deviaterikova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Elena Glebova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Elizaveta Romanova
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
| | - Alexander Karelin
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
| | - Vladimir Kasatkin
- Research Institute for Brain Development and Peak Performance, Peoples Friendship University of Russia, 117198 Moscow, Russia
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology, 117198 Moscow, Russia
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Trapani JA, Murdaugh DL. Processing efficiency in pediatric cancer survivors: A review and operationalization for outcomes research and clinical utility. Brain Behav 2022; 12:e2809. [PMID: 36330565 PMCID: PMC9759139 DOI: 10.1002/brb3.2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 09/27/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Childhood cancer and cancer-related treatments disrupt brain development and maturation, placing survivors at risk for cognitive late effects. Given that assessment tools vary widely across researchers and clinicians, it has been daunting to identify distinct patterns in outcomes across diverse cancer types and to implement systematic neurocognitive screening tools. This review aims to operationalize processing efficiency skill impairment-or inefficient neural processing as measured by working memory and processing speed abilities-as a worthwhile avenue for continued study within the context of childhood cancer. METHODS A comprehensive literature review was conducted to examine the existing research on cognitive late effects and biopsychosocial risk factors in order to conceptualize processing efficiency skill trends in childhood cancer survivors. RESULTS While a frequently reported pattern of neurobiological (white matter) and cognitive (working memory and processing speed) disruption is consistent with processing efficiency skill impairment, these weaknesses have not yet been fully operationalized in this population. We offer a theoretical model that highlights the impacts of a host of biological and environmental factors on the underlying neurobiological substrates of cancer survivors that precede and may even predict long-term cognitive outcomes and functional abilities following treatment. CONCLUSION The unified construct of processing efficiency may be useful in assessing and communicating neurocognitive skills in both outcomes research and clinical practice. Deficits in processing efficiency may serve as a possible indicator of cognitive late effects and functional outcomes due to the unique relationship between processing efficiency skills and neurobiological disruption following cancer treatment. Continued research along these lines is crucial for advancing childhood cancer outcomes research and improving quality of life for survivors.
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Affiliation(s)
- Julie A Trapani
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Donna L Murdaugh
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
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Thibodaux LK, Bledsoe J, Breiger D. Sex Differences, Academic Outcomes, and the Impact of Cranial Radiation in Pediatric Medulloblastoma. JOURNAL OF PEDIATRIC NEUROPSYCHOLOGY 2022. [DOI: 10.1007/s40817-022-00131-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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Levitch CF, Holland AA, Bledsoe J, Kim SY, Barnett M, Ramjan S, Sands SA. Comparison of neuropsychological functioning in pediatric posterior fossa tumor survivors: Medulloblastoma, low-grade astrocytoma, and healthy controls. Pediatr Blood Cancer 2022; 69:e29491. [PMID: 34842359 PMCID: PMC10409501 DOI: 10.1002/pbc.29491] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Neuropsychological comparison of medulloblastoma (MB) and cerebellar low-grade astrocytoma (LGA) survivors to controls can clarify treatment-related neurocognitive late effects. While both brain tumor groups undergo surgery to the posterior fossa, children with MB additionally receive craniospinal irradiation with boost and chemotherapy. This study provides an updated comparison of neuropsychological functioning in these two groups and examines effects of demographic risk factors upon outcomes. PROCEDURE Forty-two children (16 MB, nine LGA, and 17 controls) completed measures of intellectual functioning, verbal learning/memory, visual-motor integration, and fine-motor functioning. The effects of age at diagnosis, time since diagnosis, gender, fatigue, and social status on neuropsychological functioning were examined. RESULTS MB survivors demonstrated the worst neurocognitive late effects, but they were less severe and extensive than in prior studies. LGA survivors' mean scores were below normative expectations in working memory, processing speed, and fine-motor functioning. In this overall sample, processing speed difficulties were independent of fine-motor functioning and fatigue. Higher parental education was associated with better intellectual functioning, working memory, delayed recall, and visual-motor integration. Neuropsychological function was not associated with gender, age at diagnosis, or time since diagnosis. CONCLUSION The results support that contemporary treatment approaches with craniospinal irradiation plus boost and chemotherapy confer the greatest risk for late effects, while surgical resection is associated with subtle but important neurocognitive difficulties. Ultimately, this study furthers our understanding of factors impacting neuropsychological function in pediatric MB and LGA survivors and contributes to empirical support for close monitoring and targeted interventions into survivorship.
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Affiliation(s)
- Cara F. Levitch
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alice Ann Holland
- University of Texas Southwestern Medical Center, Department of Psychiatry, Dallas, Texas
- Children’s Medical Center Dallas, Department of Psychiatry, Dallas, Texas
| | - Jesse Bledsoe
- Seattle Children’s Hospital, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
- University of Washington School of Medicine, Department of Psychiatry and Behavioral Medicine, Seattle, Washington
| | - Soo Young Kim
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Marie Barnett
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sameera Ramjan
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Stephen A. Sands
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
- Department of Pediatrics, Memorial Sloan Kettering Cancer Center, New York, New York
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Slykerman RF, Jenner E, Tsui K, Laughton S. Neuropsychological assessment of paediatric brain tumour survivors: Factors associated with assessment. J Paediatr Child Health 2021; 57:1612-1616. [PMID: 34014589 DOI: 10.1111/jpc.15568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 11/28/2022]
Abstract
AIM Paediatric brain tumour survivors are at increased risk of neurocognitive deficits that affect their education. The aim of this study was to assess the proportion of brain tumour survivors who historically received a neuropsychological assessment and examine the demographic and treatment-related variables associated with neuropsychological assessment. A further aim was to determine the number and treatment profile of brain tumour survivors who would benefit from neuropsychological assessment. METHODS Data from the New Zealand Children's Cancer Registry including treatments received, was used to identify children treated for a brain tumour at Starship Children's Hospital between January 2009 and December 2015. Clinical records were examined for evidence of a neuropsychological assessment in the form of a written report. Logistic regression models were used to determine factors associated with receipt of an assessment. RESULTS Of the 132 brain tumour survivors, 37 (28.0%) had evidence of a neuropsychological assessment in their clinical records. In adjusted analysis, children who were treated with all three of surgery, chemotherapy and radiotherapy (n = 38) were more likely to have had an assessment (odds ratio: 12.90; 95% confidence interval: 4.76-34.93) than children who had either no treatment, chemotherapy alone, surgery alone or chemotherapy and surgery (n = 73). Treatment with radiotherapy alone or with either chemotherapy or surgery (n = 21) was not significantly associated with receipt of assessment (odds ratio = 2.40; 95% confidence interval: 0.69-8.37). CONCLUSIONS It is important to identify the number of children who might benefit from neuropsychological assessment to inform prioritisation within existing resource and plan for additional resource if required. With a focus on reducing late effects, it is imperative that neuropsychological assessment is an integral component of a paediatric brain tumour programme.
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Affiliation(s)
- Rebecca F Slykerman
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Emily Jenner
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Karen Tsui
- Starship Children's Health, Starship Blood and Cancer Centre, Auckland, New Zealand
| | - Stephen Laughton
- Starship Children's Health, Starship Blood and Cancer Centre, Auckland, New Zealand
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Rubin JB, Schlaggar BL. To each, his/her own. Neuro Oncol 2019; 21:1217-1218. [DOI: 10.1093/neuonc/noz143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joshua B Rubin
- Departments of Pediatrics and Neuroscience, Washington University School of Medicine, St Louis, Missouri
| | - Bradley L Schlaggar
- Kennedy Krieger Institute and Departments of Neurology and Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
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