NCOG-48. Level of Resection Predicts Deficits in Psychosocial and Executive Functioning in Pediatric Brain Tumor Survivors Treated with Surgery Only

Abstract Pediatric brain tumor survivors are known to be at risk for long-term deficits in psychosocial and executive functioning. Few studies focus on patients treated with surgery alone, with sparsely reported long-term outcomes. We aimed to characterize clinical factors that predict adverse outcomes in this population. We identified patients diagnosed with a brain tumor at Texas Children’s Hospital from 2012 to 2019 who were treated with surgical resection alone. Initial assessment occurred within six months of diagnosis and were repeated annually thereafter for three years. We examined the parent-report Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC), including the sub-indices of Behavioral Regulation (BRI) and Metacognition (MI). Furthermore, we examined the parent-report Behavior Assessment System for Children (BASC): Behavioral Symptoms Index (BSI), Externalizing Symptoms (ES), Internalizing Symptoms (IS). Multi-variate analysis was completed with linear mixed modeling to assess the impact of gross total resection (GTR) on our outcome measures. Our analysis included 44 patients aged 3 to 17 years (mean 9.5 years). The most common diagnosis was low grade glioma (29/44, 66%) and the majority underwent GTR of their tumor (37/44, 84%). After controlling for tumor location, pathology, age, sex, and baseline FSIQ, patients who underwent GTR, compared to those who did not, had significantly higher levels of impairment across all time points for global executive function, behavioral regulation, behavioral symptoms, and externalizing symptoms (all comparisons p ≤ 0.01). There was no significant interaction identified over time. Although the medical needs of patient who receive GTR as curative therapy are typically low, children undergoing GTR experience increased executive and behavioral symptoms long-term compared to children undergoing subtotal resections. Our findings highlight the importance of increased psychosocial and neurocognitive monitoring in this vulnerable population to facilitate earlier access to psychological intervention and mitigate these long-term deficits.