A influência de fatores socioculturais e clínicos sobre o perfil cognitivo de crianças e adolescentes sobreviventes de tumores de fossa posterior

Abstract

Central Nervous System tumors are the most common pediatric solid neoplasms. The posterior fossa, notably the cerebellum, is the region with the highest incidence, where medulloblastomas and pilocytic astrocytomas are more frequent. Medulloblastomas are treated with neurosurgery (NC), systemic chemotherapy (QT) and cranio-spinal radiotherapy (RTX), while most astrocytomas require NC only. The survival range is achieved through sequelae on the development of survivors, especially associated with the neurotoxicity of anti-neoplastic treatment, to which damage to the integrity of the white matter (SB) is attributed. Different factors are added to this complex mosaic, with emphasis on sociocultural aspects, which, independently or superimposed, dialectically structure the development processes. The present work aimed to investigate the influence of sociocultural and clinical aspects on the cognitive profile of children and adolescent survivors of Posterior Fossa Tumors (PFT). The research was subdivided into three studies: 1) Influence of the maternal schooling on intellectual capacity in pediatric PFT survivors; 2) Memory investigation in pediatric PFT survivors; 3) Brain lesions in childhood: a case study of a malignant posterior fossa tumor. Thirty seven subjects aged six to 16 years composed the clinical group and 25 subjects – participants in study 2 only -, the control group, paired 1:1 according to sex, age, type of school, and socioeconomic status of the participants in study 2. The Neuropsychological evaluation performed with the participants and the data analyzed used descriptive and inferential statistical tools. In study 1, we found that the type of treatment was significantly associated nonverbal cognitive functions of intellectual ability, while the maternal schooling variable was associated with impacts on verbal dimensions. In study 2, we found that the clinical group submitted only to NC showed impairments, especially in the verbal working memory, while the broader mnemic impacts were related to the group submitted to antineoplastic therapies. Lower working memory performances were identified in children whose mothers had a lower level of education. In study 3, the neuropsychological profile of the child medulloblastoma survivor revealed relatively mild impairments considering the expected cognitive deficits for subjects treated by antineoplastic therapies. The findings suggest that the sociocultural conditions that permeated the child's development acted as protective factors against the emergence of more serious cognitive sequelae. Thus, the expressive complexity underlying the manifestation of the cognitive profiles presented by this population is highlighted and the central role of the variable maternal education is revealed.