Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: a report from the Childhood Cancer Survivor Study

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background.</div>Medulloblastoma is the most common malignant childhood brain tumor, although long-term risks for chronic neurologic health and psychosocial functioning in aging adult survivors are incompletely characterized.<div class="boxTitle">Methods.</div>The Childhood Cancer Survivor Study (CCSS) includes 380 five-year survivors of medulloblastoma/primitive neuroectodermal tumor (PNET; median age at follow-up: 30 y, interquartile range 24–36) and sibling comparison (<span style="font-style:italic;">n</span> = 4031). Cumulative incidence of neurologic health conditions was reported. Cox regression models provided hazard ratios (HRs) and 95% CIs. Cross-sectional outcomes were assessed using generalized linear models.<div class="boxTitle">Results.</div>Compared with siblings, survivors were at increased risk of late-onset hearing loss (HR: 36.0, 95% CI: 23.6–54.9), stroke (HR: 33.9, 95% CI: 17.8–64.7), seizure (HR: 12.8, 95% CI: 9.0–18.1), poor balance (HR: 10.4, 95% CI: 6.7–15.9), tinnitus (HR: 4.8, 95% CI: 3.5–6.8), and cataracts (HR: 31.8, 95% CI: 16.7–60.5). Temporal/frontal lobe radiotherapy of 50 Gy or more increased risk for hearing loss (HR: 1.9, 95% CI: 1.1–1.3), seizure (HR: 2.1, 95% CI: 1.1–3.9), stroke (HR: 3.5, 95% CI: 1.3–9.1), and tinnitus (HR: 2.0, 95% CI: 1.0–3.9). Survivors were less likely than siblings to earn a college degree (relative risk [RR]: 0.49, 95% CI: 0.39–0.60), marry (RR: 0.35, 95% CI: 0.29–0.42), and live independently (RR: 0.58, 95% CI: 0.52–0.66).<div class="boxTitle">Conclusions.</div>Adult survivors of childhood medulloblastoma/PNET demonstrate pronounced risk for hearing impairment, stroke, lower educational attainment, and social independence. Interventions to support survivors should be a high priority.</span>

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