Longitudinal associations between exposure to anesthesia and neurocognitive functioning in pediatric medulloblastoma

Eur J Cancer. 2021 May:148:103-111. doi: 10.1016/j.ejca.2021.02.010. Epub 2021 Mar 17.

Abstract

Aim: To examine whether anesthesia exposure is associated with neurocognitive decline in pediatric medulloblastoma.

Methods: Patients were treated at St. Jude Children's Research Hospital and completed ≥2 protocol-directed neurocognitive assessments (n = 107) as part of a multisite clinical trial for pediatric medulloblastoma (NCT00085202). Patients received risk-adapted craniospinal photon irradiation, followed by four cycles of high-dose chemotherapy and stem cell rescue. Neurocognitive testing was completed at study baseline (after surgery and <2 weeks of starting radiation therapy) and annually for 5 years. Data on anesthesia exposure during treatment was abstracted from medical records.

Results: Patients were 10.2 years at diagnosis on average (SD = 4.5; 37% female, 73% average-risk). Mean cumulative anesthesia duration was 20.4 h (SD = 15.2; range 0.7-55.6 h). In the overall group, longer anesthesia duration was associated with greater declines in IQ (Estimate = -0.08, P < 0.001), attention (Estimate = -0.10, P < .001) and processing speed (Estimate = -0.13, P < 0.001). Similar results were shown in subgroups of patients who were <7 years at diagnosis (IQ = -0.14, P = 0.027; Attention = -0.25: P = 0.011), ≥7 years at diagnosis (Attention = -0.07, P = 0.039; Processing Speed = -0.08, P = 0.022), treated for high-risk disease (IQ = -0.09, P = 0.024; Attention = -0.11, P = 0.034; Processing Speed = -0.13, P = 0.001), or treated for average-risk disease (IQ = -0.05, P = .022; Attention = -0.08, P = 0.011; Processing Speed = -0.10, P < 0.001).

Conclusion: Greater anesthesia exposure is a risk factor for clinically significant neurocognitive decline, in addition to factors of age at diagnosis and treatment risk arm. This result is notable as there are evidence-based strategies that can limit the need for anesthesia. Limiting anesthesia exposure, as feasible, may mitigate neurocognitive late effects, and thus, improve quality of life for survivors.

Keywords: Anesthesia; Brain tumour; Children; Longitudinal; Medulloblastoma; Neurocognitive.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anesthesia / adverse effects*
  • Cerebellar Neoplasms / pathology
  • Cerebellar Neoplasms / therapy*
  • Child
  • Child, Preschool
  • Cognition Disorders / etiology
  • Cognition Disorders / pathology*
  • Cranial Irradiation / adverse effects*
  • Female
  • Follow-Up Studies
  • Humans
  • Longitudinal Studies
  • Male
  • Medulloblastoma / pathology
  • Medulloblastoma / therapy*
  • Mental Status and Dementia Tests
  • Prognosis
  • Quality of Life*
  • Risk Factors
  • Young Adult

Associated data

  • ClinicalTrials.gov/NCT00085202