Early Cognitive Outcomes Following Proton Radiation in Pediatric Patients With Brain and Central Nervous System Tumors

• Published in: International journal of radiation oncology, biology, physics Vol. 93; no. 2; pp. 400 - 407
• Main Authors: Pulsifer, Margaret B., Sethi, Roshan V., Kuhlthau, Karen A., MacDonald, Shannon M., Tarbell, Nancy J., Yock, Torunn I.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.10.2015
• Subjects: Adolescent; Analysis of Variance; BRAIN; Brain Neoplasms - radiotherapy; Central Nervous System Neoplasms - radiotherapy; CHEMOTHERAPY; Child; Cognition - radiation effects; COMPARATIVE EVALUATIONS; Comprehension - radiation effects; Craniospinal Irradiation - adverse effects; Craniospinal Irradiation - methods; Female; GLIOMAS; Hematology, Oncology and Palliative Medicine; HISTOLOGY; Humans; Intelligence - radiation effects; Male; Medulloblastoma - radiotherapy; Memory, Short-Term - radiation effects; PATIENTS; PEDIATRICS; Proton Therapy - adverse effects; Proton Therapy - methods; PROTONS; RADIATION DOSES; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; RADIOTHERAPY; SURGERY; Young Adult
• ISSN: 0360-3016; 1879-355X; 1879-355X
• DOI: 10.1016/j.ijrobp.2015.06.012

To report, from a longitudinal study, cognitive outcome in pediatric patients treated with proton radiation therapy (PRT) for central nervous system (CNS) tumors. Sixty patients receiving PRT for medulloblastoma (38.3%), gliomas (18.3%), craniopharyngioma (15.0%), ependymoma (11.7%), and other CNS tumors (16.7%) were administered age-appropriate measures of cognitive abilities at or near PRT initiation (baseline) and afterward (follow-up). Patients were aged ≥6 years at baseline to ensure consistency in neurocognitive measures. Mean age was 12.3 years at baseline; mean follow-up interval was 2.5 years. Treatment included prior surgical resection (76.7%) and chemotherapy (61.7%). Proton radiation therapy included craniospinal irradiation (46.7%) and partial brain radiation (53.3%). At baseline, mean Wechsler Full Scale IQ was 104.6; means of all 4 Index scores were also in the average range. At follow-up, no significant change was observed in mean Wechsler Full Scale IQ, Verbal Comprehension, Perceptual Reasoning/Organization, or Working Memory. However, Processing Speed scores declined significantly (mean 5.2 points), with a significantly greater decline for subjects aged <12 years at baseline and those with the highest baseline scores. Cognitive outcome was not significantly related to gender, extent of radiation, radiation dose, tumor location, histology, socioeconomic status, chemotherapy, or history of surgical resection. Early cognitive outcomes after PRT for pediatric CNS tumors are encouraging, compared with published outcomes from photon radiation therapy.