|Reviewer: Charles E Stewart, MD PhD|
|The Abramson Cancer Center of the University of Pennsylvania|
Authors: BJ Spiegler, E Bouffet, ML Greenberg, et al.
Treatment of pediatric posterior fossa tumors has evolved in the multimodality setting to the point that emphasis is no longer just on improving survival but in minimizing toxicities. Neurocognitive decline in patients with a primary brain malignancy treated with a multimodality approach including surgery, radiation and in the majority of cases chemotherapy has been documented by a number of studies. Patients are now living longer, long enough to demonstrate significant neurocognitve deficits in some cases. Confounding our ability to refine treatment strategies is the relative rarity in absolute numbers of study subjects. The prospect of a defining randomized study remains elusive. To that end, Spiegler and colleagues have conducted a retrospective study of change in neurocognitive functioning in patients with posterior fossa tumors after treatment with surgery, cranial radiation, and in most cases chemotherapy in childhood.
Results and Conclusions
This study reports on a retrospective trial of change in neurocognitive functioning in patients with posterior fossa tumors after treatment with surgery, cranial radiation, and in most cases chemotherapy in childhood. Since most pediatric patients with posterior fossa tumors are treated with a similar multimodality approach, this study forms an observational basis regarding outcomes patients, families, and practitioners can expect to encounter. The study further makes inroads by examining specific changes in neurocognitive function not previously studied in this population.
The failure of this study to examine and separate contributions of a neoplastic primary in brain, surgery, chemotherapy, or radiation to neurocognitive decline in this population lend a somewhat hollow ring to its title. It is likely that radiation to the whole brain or posterior fossa has a detrimental effect on neurocognitive function. Its relative contribution to the decline seen in this population remains uncharacterized.