Danielle Garcia

Intellectual impairment after treatment for medulloblastoma and astrocytoma in childhood: the Brazilian experience.

Background This study investigated the impact of posterior fossa tumors and their respective treatments, and the impact of clinical and sociodemographic variables, on the intelligence quotient (IQ) of Brazilian children. Methods Twenty patients took part in the study, of which 13 were diagnosed with astrocytoma (average age at evaluation 10.2 y) and 7 with medulloblastoma (average age at evaluation 9.2 y). The first subgroup was submitted exclusively to tumor resection surgery and the second subgroup underwent surgery, chemotherapy (Vincristine, Cisplatine, and Carmustine), and radiotherapy (total dose of 54 Gy). The Wechsler Intelligence Scale for Children (WISCIII) was used. Results The following statistically significant effects were identified: treatment modality on performance intelligence quotient scores (P=0.02) and processing speed index (PSI) (P=0.01); presence of hydrocephalus at diagnosis on verbal intelligence quotient (P=0.04); tumor localization on perceptual organization index (P=0.03); time interval between diagnosis and neuropsychological evaluation on PSI (P=0.05) and freedom from distraction index (P=0.03); and level of parental formal education on full scale IQ (P=0.02). Conclusions Exposure to radiotherapy has a significant effect on processing speed and consequently on global intellectual capacity. The impact on intelligence of clinical and sociodemographic variables such as tumor localization, time interval between diagnosis and cognitive evaluation, and parental level of formal education is confirmed in the specific setting of a developing country.

Treatment Related Cognitive Impairment in Pediatric Oncology Patients: A Brazilian Experience

Background: Acute Lymphoblastic leukemia (ALL) and Posterior Fossa Tumors (PFT) are the most common types of cancer in Brazilian children. Parallel to the sophistication of treatment and increased survival rates, the concern about the neurotoxicity of anti-neoplastic treatment and its impact on neurodevelopment has been growing. The objective of this study was to compare the cognitive impact of treatment modality on intellective capacity of children survivors of PFT and ALL. Method: 22 Children and adolescents aged from 6 to 14 years old have participated in this study, being 06 children diagnosed with Astrocytoma, 06 diagnosed with medulloblastoma and 10 diagnosed with ALL. Children with astrocytoma underwent surgery for tumor resection; children with medulloblastoma were submitted to surgical resection, systemic chemotherapy and cranial and neuraxis radiation therapy (54Gy) and; children with ALL underwent systemic and intrathecal chemotherapy. Intellectual functioning was evaluated through WISC-III, and performance of subgroups was compared using One Way ANOVA followed by post hoc LSD. Results: Children with astrocytoma obtained average performance in all assessed domains, while children with medulloblastoma and ALL obtained downgraded scores. In all indices children with ALL obtained better results than children with medulloblastoma, except on verbal scores (VIQ and VCI) and Freedom from Distractibility Index (FDI). Statistical analysis revealed significant contrasts in performance of groups, mainly between children with medulloblastoma and other groups in non-verbal scores, as Processing Speed Index (PSI). Conclusion: Data suggest that the combination of surgery, systemic chemotherapy and radiotherapy may intensify the incidence of cognitive effects. Moreover, reinforce the hypothesis that cranial radiation therapy underlies severe cognitive losses, through damage to cortical and subcortical white matter, so that motor and mental processing speed is affected. The combination of intrathecal and systemic chemotherapy in turn promotes significant impacts on executive functioning, in particular on working memory.

REINSERÇÃO ESCOLAR E LEUCEMIA: TRADUÇÃO E ADAPTAÇÃO DO QUESTIONÁRIO COMPORTAMENTAL DEASY-SPINETTA

The Deasy-Spinetta Behavior Questionnaire (DSBQ) offers an important contribution to the monitoring of school reintegration of children with cancer, especially those diagnosed with Acute Limphoblastic Leukemia (ALL), which account for the main survivors group in pediatric oncology. DSBQ investigates emotional, learning and socialization dimensions through 38 questions. The present study carried out the translation and cross-cultural adaptation of the DSBQ to Brazilian Portuguese on the basis of six steps: approval request of DSBQ authors for the translation and cross-cultural adaptation of the instrument; translation and reverse translation (or back translation); comparison of reverse translation with the original French version; assessment of a specialist committee regarding the need of items review and/or semantic adjustment; the submission of 20 teachers to Brazilian version in order to evaluate the intelligibility of items. Teachers considered the final version of the translated and adapted instrument as appropriate and intelligible, since a final consensus gross value of 81% was verified. The degree of agreement between raters was 0.6882 (±0.0247), which indicates a substantial agreement according to Fleiss’ Kappa measure. The development, translation and adaptation of foreign instruments tailored to the comprehension of impairments that impact educational context of children with ALL is crucial, given the lack of such assessment tools, the frequent report of learning disabilities among these children and the need to characterize the transient and late effects associated to illness and to the treatment of childhood cancer, which affect scholar development and quality of life of this clinical subgroup.

Performance of Children in Phonemic and Semantic Verbal Fluency Tasks

El presente estudio investigo el desempeno de 102 ninos de la region nordeste, entre 7 y 10 anos, en tareas de fluidez verbal fonetica y semantica. Participaron 102 sujetos de ambos sexos, que realizaron tres tareas de fluencia fonetica y tres de fluencia semantica. Los datos encontrados fueron sometidos a analisis correlacionales y de varianza, teniendo en cuenta la influencia de las variables edad y sexo sobre el desempeno de los participantes. El sexo no influyo en el desempeno de los ninos. Fueron verificados contrastes significativos entre las edades, con un mejor desempeno en tareas del componente fonologico a medida que avanza la edad comparandolo con el semantico. Los resultados encontrados parecen estar respaldados por aspectos neurologicos del desarrollo, dado que los sistemas de memoria explicita presentan un proceso de maduracion mas precoz y de consolidacion anterior en relacion a las funciones ejecutivas y los lobulos frontales, cuyo desarrollo se extiende a la edad adulta.O presente estudo investigou o desempenho de criancas da regiao Nordeste, entre 7 e 10 anos, em tarefas de fluencia verbal fonologica e semântica. Participaram da pesquisa 102 sujeitos de ambos os sexos, os quais realizaram tres tarefas de fluencia fonologica e tres de fluencia semântica. Os dados encontrados foram submetidos a analises correlacionais e de variância, considerando a influencia das variaveis idade e sexo sobre o desempenho dos participantes. Nao houve efeito do sexo sobre o desempenho das criancas. Contrastes significativos entre as faixas etarias foram verificados, observando-se melhor desempenho nas tarefas do componente fonologico com o avanco da idade e em comparacao com o semântico. Os resultados encontrados parecem estar respaldados por aspectos neurodesenvolvimentais, visto que os sistemas de memoria explicita apresentam curso maturacional mais precoce e de consolidacao anterior em relacao as funcoes executivas e os lobos frontais, cujo desenvolvimento se estende a idade adulta.

Neuropsicologia e Oncologia Pediátrica: um diálogo em emergência

Dados do INCA estimam que anualmente cerca de 11.530 casos de neoplasias sao diagnosticados em criancas e adolescentes. O aumento do numero de sobreviventes vem crescendo, junto com as sequelas cognitivas decorrentes da doenca e de seu tratamento. Nesse sentido, o presente artigo discute acerca da pertinencia do estabelecimento de dialogo entre a neuropsicologia e a oncologia. O artigo aborda os dois subtipos de câncer mais comuns na infância e adolescencia: os tumores de fossa posterior e a leucemia linfoide aguda. A discussao sera ilustrada com resultados oriundos de dois estudos distintos realizados em servicos publicos de referencia no tratamento do câncer pediatrico na Regiao Nordeste do Brasil.

Desempenho Intelectual Pós Tratamento de Câncer: Um Estudo com Crianças

Concerns about the neurotoxicity of antineoplastic treatment and neurodevelopment are increasing nowadays. The aim of this study was to compare the impact of treatment modality on intellectual functioning of 22 survivors of Posterior Fossa Tumors and Acute Lymphoblastic Leukemia aged from six to 14 years. The astrocytoma group underwent surgery; the medulloblastoma group underwent surgery, systemic chemotherapy, and cranial and neuraxis radiation (54Gy); the LLA group underwent systemic and intrathecal chemotherapy. Only the astrocytoma group obtained average performance. Significant contrasts were obtained between groups, especially among the medulloblastoma group and others in non-verbal scores. Results suggest that the combination of surgery, radiotherapy and systemic chemotherapy increase the cognitive sequelae and enhance the hypothesis that radiation damages white matter. The association between intrathecal and systemic chemotherapy leads to significant impact on executive functioning.