Neurocognitive

Only a small number of studies have focused on the neurocognitive impact of the intensive therapy that received high-risk neuroblastoma patients (Kelaghan et al. 1988; Simms et al. 1988; Kramer et al. 1992; Phipps et al. 1995; Mitby et al. 2003; Notteghem et al. 2003). Risk factors for neurocognitive impairment include age less than 3 years, high-dose chemotherapy with autologous bone marrow transplantation, and cranial radiation (Phipps et al. 2000). The impact of TBI on the neurocognitive impairment remains controversial (Simms et al. 1988; Kramer et al. 1992; Phipps et al. 1995; Phipps et al. 2000). Notteghem et al. (2003) recently reviewed the neuropsychological outcomes of 46 high-risk neuroblastoma patients with a mean follow-up of 9.1 years. Survivors of neuroblas-toma had an overall performance and skills in the normal range; however, patients who were younger than 3 years when they received the treatment had more visuospatial difficulties and a worse visual memory. Furthermore, hearing loss due to cisplatin was associated with defects in verbal performance (Notteghem et al. 2003).

A recent CCSS study evaluated the educational achievement of a large cohort of childhood cancer survivors. Compared with normal siblings, neurob-lastoma survivors were significantly more likely to use special education services because of lower tests scores, and were significantly less likely to complete high school (odds ratio 1.7); however, when the neu-roblastoma survivors received special education services, risk estimates approximated those of the sibling population. In the same study, age at diagnosis under 6 years and cranial radiation were associated independently with the use of special education services among all the survivors (Mitby et al. 2003). In contrast, another study reported a similar educational achievement between survivors of neuroblas-toma and siblings (Kelaghan et al. 1988).

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