Survival and long-term health and cognitive outcomes after low-grade glioma

Gregory Armstrong, Heather M. Conklin, Sujuan Huang, Deokumar Srivastava, Robert Sanford, David W. Ellison, Thomas E. Merchant, Melissa M. Hudson, Mary Ellen Hoehn, Leslie L. Robison, Amar Gajjar, E. Brannon Morris

Research output: Contribution to journalArticle

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Abstract

Long-term morbidity for children with low-grade glioma (LGG) requires exposure-specific characterization. Overall survival (OS) and progression-free survival (PFS) were estimated for 361 children diagnosed with LGG between 1985 and 2007 at a single institution. Five-year survivors (n = 240) received risk-based clinical assessment. Cumulative incidence of late effects 15 years from diagnosis were estimated. Risk factors for adverse health were identified using Fine and Gray's approach to Cox's proportional hazards model, accounting for death as a competing risk. OS at 15 years was 86% (95% confidence interval [CI] 82%-90%), and PFS was 55% (95% CI 51%-58%). Among the 240 5-year survivors, the 5-, 10-, and 15-year cumulative incidence of adverse outcomes included blindness: 10%, 13%, and 18%, respectively; hearing loss: 8%, 14%, and 22%; obesity/overweight: 18%, 35%, and 53%; hyperinsulinism: 1%, 5%, and 24%; growth hormone deficiency: 13%, 27%, and 29%; thyroid hormone deficiency: 16%, 28%, and 33%; and adrenocorticotropic hormone (ACTH) deficiency: 12%, 22%, and 26%. Multivariable models demonstrated radiation therapy to be a significant independent predictor of hearing loss, growth hormone deficiency, abnormal thyroid function, and ACTH deficiency. Diencephalic location was a statistically significant independent risk factor for blindness, growth hormone deficiency, abnormal thyroid function, and ACTH deficiency. Among the 182 5-year survivors assessed for intellectual function, 34% had an intelligence quotient (IQ) below average (<85), associated with younger age at diagnosis, epilepsy, and shunt placement. Survivors of childhood LGG experience substantial long-term adverse effects that continue to increase well beyond the 5-year survival time point.

Original languageEnglish (US)
Pages (from-to)223-234
Number of pages12
JournalNeuro-Oncology
Volume13
Issue number2
DOIs
StatePublished - Feb 1 2011

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Thyroid Hormones
Glioma
Growth Hormone
Blindness
Hearing Loss
Disease-Free Survival
Survival
Survivors
Health
Confidence Intervals
Incidence
Hyperinsulinism
Intelligence
Proportional Hazards Models
Epilepsy
Radiotherapy
Obesity
Morbidity
Adrenocorticotropic hormone deficiency

All Science Journal Classification (ASJC) codes

  • Oncology
  • Clinical Neurology
  • Cancer Research

Cite this

Armstrong, G., Conklin, H. M., Huang, S., Srivastava, D., Sanford, R., Ellison, D. W., ... Morris, E. B. (2011). Survival and long-term health and cognitive outcomes after low-grade glioma. Neuro-Oncology, 13(2), 223-234. https://doi.org/10.1093/neuonc/noq178

Survival and long-term health and cognitive outcomes after low-grade glioma. / Armstrong, Gregory; Conklin, Heather M.; Huang, Sujuan; Srivastava, Deokumar; Sanford, Robert; Ellison, David W.; Merchant, Thomas E.; Hudson, Melissa M.; Hoehn, Mary Ellen; Robison, Leslie L.; Gajjar, Amar; Morris, E. Brannon.

In: Neuro-Oncology, Vol. 13, No. 2, 01.02.2011, p. 223-234.

Research output: Contribution to journalArticle

Armstrong, G, Conklin, HM, Huang, S, Srivastava, D, Sanford, R, Ellison, DW, Merchant, TE, Hudson, MM, Hoehn, ME, Robison, LL, Gajjar, A & Morris, EB 2011, 'Survival and long-term health and cognitive outcomes after low-grade glioma', Neuro-Oncology, vol. 13, no. 2, pp. 223-234. https://doi.org/10.1093/neuonc/noq178
Armstrong G, Conklin HM, Huang S, Srivastava D, Sanford R, Ellison DW et al. Survival and long-term health and cognitive outcomes after low-grade glioma. Neuro-Oncology. 2011 Feb 1;13(2):223-234. https://doi.org/10.1093/neuonc/noq178
Armstrong, Gregory ; Conklin, Heather M. ; Huang, Sujuan ; Srivastava, Deokumar ; Sanford, Robert ; Ellison, David W. ; Merchant, Thomas E. ; Hudson, Melissa M. ; Hoehn, Mary Ellen ; Robison, Leslie L. ; Gajjar, Amar ; Morris, E. Brannon. / Survival and long-term health and cognitive outcomes after low-grade glioma. In: Neuro-Oncology. 2011 ; Vol. 13, No. 2. pp. 223-234.
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