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Intellectual outcome after reduced-dose radiation therapy plus adjuvant chemotherapy for medulloblastoma: a
M D Ris1, R Packer, J Goldwein
1Division of Psychology, Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA. risd0@chmcc.org
Insights
Children treated for medulloblastomas/primitive neuroectodermal tumors (MB/PNET) with reduced-dose craniospinal radiotherapy (RT) and chemotherapy experienced significant intellectual decline. This outcome suggests some preservation compared to conventional RT doses, but further research is needed.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Radiation Oncology
Background:
- Medulloblastomas/primitive neuroectodermal tumors (MB/PNET) are common pediatric brain tumors.
- Craniospinal radiotherapy (RT) is a standard treatment, but can cause significant neurocognitive sequelae.
- Reduced-dose RT regimens are being explored to mitigate long-term side effects.
Purpose of the Study:
- To evaluate the intellectual outcomes in children with average-risk MB/PNETs treated with reduced-dose craniospinal RT and adjuvant chemotherapy.
- To assess the rate of change in Full Scale Intelligence Quotient (FSIQ), Verbal IQ (VIQ), and Nonverbal IQ (NVIQ).
Main Methods:
- Longitudinal intelligence testing was performed on 43 children with average-risk posterior fossa MB/PNETs.
- Patients received a reduced-dose craniospinal RT regimen (23.4 Gy neuraxis, 32.4 Gy boost) plus adjuvant chemotherapy.
- Statistical analysis was used to determine the rate of change in IQ scores.
Main Results:
- Significant annual declines were observed for FSIQ (-4.3 points), VIQ (-4.2 points), and NVIQ (-4.0 points).
- Females and younger children (<7 years) showed greater declines, particularly in VIQ and NVIQ, respectively.
- Patients with higher baseline IQ scores experienced more substantial declines.
Conclusions:
- Reduced-dose craniospinal RT combined with chemotherapy resulted in substantial intellectual loss in children with MB/PNETs.
- While suggestive of some intellectual preservation compared to conventional RT doses, the findings require further investigation.
- This study provides valuable prospective data on long-term neurocognitive outcomes in this patient population.
Purpose:
To investigate the intellectual outcomes of children with medulloblastomas/primitive neuroectodermal tumors (MB/PNET) treated with reduced-dose craniospinal radiotherapy (RT) plus adjuvant chemotherapy.
Patients And Methods:
Forty-three children with average-risk posterior fossa MB/PNETs underwent longitudinal intelligence testing. All had been treated with a reduced-dose craniospinal RT regimen (23.4 Gy to the neuraxis, 32.4-Gy boost to the posterior fossa) and adjuvant chemotherapy.
Results:
The estimated rate of change from baseline was significant for Full Scale Intelligence Quotient (FSIQ), Verbal IQ (VIQ), and Nonverbal IQ (NVIQ) (P <.001 for all three outcomes). The rate of change was estimated to be -4.3 FSIQ points per year, -4.2 VIQ points per year, and -4.0 NVIQ points per year. Females were more subject to VIQ decline than were males (P =.008), and young children (< 7 years of age) were more negatively affected than were older children, with a significant decline in NVIQ (P =.016). Finally, patients with higher baseline evaluations suffered greater declines in IQ than did those with lower baseline scores.
Conclusion:
This study represents the largest series of patients with average-risk MB/PNETs treated with a combination of reduced-dose RT and adjuvant chemotherapy whose intellectual development has been followed prospectively. Intellectual loss was substantial but suggestive of some degree of intellectual preservation compared with effects associated with conventional RT doses. However, this conclusion remains provisional, pending further research.