- •Children with medulloblastoma often receive anesthesia during treatment.
- •Anesthesia exposure is associated with neurocognitive declines over time.
- •Limiting anesthesia exposure, as feasible, may mitigate neurocognitive decline.
To examine whether anesthesia exposure is associated with neurocognitive decline in pediatric medulloblastoma.
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.
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).
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.
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Published online: March 17, 2021
Accepted: February 2, 2021
Received in revised form: January 4, 2021
Received: August 25, 2020
1Note: this work was conducted at St. Jude Children's Research Hospital; first author M.P. is now affiliated with the Princess Máxima Center for Pediatric Oncology.
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