Long-term quality of life and neuropsychologic functioning for patients with CNS germ-cell tumors: From the First International CNS Germ-Cell Tumor Study

This study evaluated the quality of life and neuropsychologic functioning a mong patients enrolled between 1989 and 1993 in the First International CNS Germ-Cell Tumor Study. Quality-of-life questionnaires (Short Form-36 or Ch ild Health Questionnaire) were completed on 43 patients at median follow-up of 6.1 years after diagnosis (range, 4.5-8.8 years), and intellectual and academic testing was performed on 22 patients. Psychosocial and physical fu nctioning of patients aged 19 years and older at follow-up was within the a verage range, whereas the same functioning for patients aged 18 years and y ounger, as reported by their parents at follow-up, was low average and bord erline, respectively. Overall psychosocial and physical health summary scor es were positively correlated with age at diagnosis for both groups combine d. Those who received CNS radiation therapy (n = 29) reported significantly worse physical health, but similar psychosocial health, compared with thos e treated without radiation. Neuropsychologic testing indicated full-scale and verbal IQ, reading, spelling, and math skills in the average range, and performance IQ in the low average range. Intelligence and math skills were positively correlated with age at diagnosis. Those with germinomas signifi cantly outperformed those with nongerminomatous/mixed tumors on all neurops ychological measures administered. Younger patients diagnosed with CNS germ -cell tumors are at increased risk for psychosocial and physical problems a s well as neuropsychologic deficits. Exposure to irradiation adversely affe cts overall physical functioning, whereas tumor pathology appears to be a s alient neurocognitive risk factor. Collaborative and randomized studies are required to further elucidate the late effects arising from factors such a s age at diagnosis, tumor histology, level of irradiation therapy, and chem otherapy toxicity among these young and potentially curable patients.