Cognitive and Adaptive Outcomes Following Proton Radiation for Pediatric Patients with Brain Tumors

Publication date: Available online 6 June 2018
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Margaret B. Pulsifer, Haley Duncanson, Julie Grieco, Casey Evans, Irene Delgado Tseretopoulos, Shannon MacDonald, Nancy J. Tarbell, Torunn I. Yock
PurposeRadiation therapy is integral in treatment of pediatric brain tumors, but is associated with negative long-term sequelae. Proton radiotherapy (PRT), which enables better focusing of radiation to tumors, may entail fewer sequelae. This prospective study examined cognitive and adaptive functioning in children and young adults treated with PRT.Methods and Materials155 patients were assessed using age-appropriate measures for cognitive and adaptive functioning at start of or during PRT (baseline) and follow-up. Mean age at baseline was 8.9 years; mean follow-up interval was 3.6 years. Diagnoses included medulloblastoma, craniopharyngioma, ependymoma, glial, germ cell, and others. The sample was divided by age at baseline: <6 years (37%) and ≥6 years (63%), and by PRT field: craniospinal irradiation (CSI) (39%) and focal irradiation (61%).ResultsMean IQ and adaptive scores were in the average range at baseline and follow-up. Overall, mean IQ declined from 105.4 to 102.5 (P = 0.005); however, only the younger/CSI group showed significant decline. CSI patients, regardless of age, appeared particularly vulnerable in IQ, processing speed, and working memory. Adaptive skills were stable across the four age-by-treatment field groups.ConclusionsAt a mean of 3.6 years after PRT, IQ declined slightly for the group, largely due to significant IQ decline in younger patients treated with CSI. No significant change was seen in patients <6 years treated with focal PRT or in older patients. Adaptive skills remained stable across age and treatment type.

Teaser

Radiation therapy for brain tumors is associated with declines in intelligence (IQ) and adaptive functioning. Proton radiotherapy (PRT), which limits dose to normal tissue, could improve outcome. This study assessed 155 pediatric patients aged 1–22.5 years at PRT initiation and a mean of 3.6 years thereafter. IQ declined slightly for the group, largely due to significant decline in patients <6 years treated with craniospinal irradiation. Adaptive skills remained stable across age and treatment type.


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