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Updated: Jul 1, 2026
Quantifying Cognitive Decrements Caused by Cranial Radiotherapy
Published on: October 18, 2011
[Neuropsychological sequelae in children with AML treated with or without prophylactic CNS-irradiation]
D Reinhardt1, C Thiele, U Creutzig
1Pädiatrische Hämatologie/Onkologie, Westfälischen-Wilhelms Universität, Münster. dreinh@uni-muenster.de
Insights
Cranial irradiation (CRT) in children with acute myeloid leukemia (AML) did not cause significant intellectual deficits but was linked to increased learning problems and concentration issues, especially in girls and younger patients.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Psychology
Background:
- Acute myeloid leukemia (AML) treatment in children often involves cranial irradiation (CRT) to reduce relapse rates.
- CRT is associated with potential long-term adverse cognitive effects.
- The impact of CRT on neuropsychological outcomes in pediatric AML survivors requires careful evaluation.
Purpose of the Study:
- To retrospectively assess the impact of CRT on neuropsychological function in pediatric AML survivors.
- To compare cognitive and learning outcomes between children who received CRT and those who did not.
Main Methods:
- A cohort of 53 pediatric AML survivors from the AML-BFM-87 study were evaluated.
- Patients who relapsed, had initial CNS involvement, or underwent transplantation were excluded.
- Neuropsychological function was assessed using attention/concentration tests (d2) and intelligence tests (Raven's Matrices), supplemented by patient/parent interviews.
Main Results:
- No significant differences in standardized intelligence tests were observed between irradiated and non-irradiated groups.
- Irradiated patients showed lower scores in attention and concentration tests (d2).
- Irradiated patients reported a higher incidence of learning problems and subjective concentration deficits, particularly girls and younger children.
Conclusions:
- While cranial irradiation in pediatric AML patients did not lead to significant intellectual impairment on standardized tests, it was associated with increased self-reported learning and concentration difficulties.
- These findings highlight the need for continued monitoring and potential interventions for cognitive side effects in pediatric AML survivors treated with CRT.
- Subgroup analyses suggest that girls and younger children may be more vulnerable to these neurocognitive effects.
Background:
In study AML-BFM 87 the relapse rate was lower in patients receiving cranial irradiation (CRT). However, CRT has always been associated with adverse cognitive side effects. Therefore, the impact of CRT on neuropsychological function in children with AML was retrospectively evaluated.
Patients:
We tested 53 children (30 boys, 23 girls) treated according to the AML-BFM-87 protocol (median age at diagnosis: 8.5 years, range 0.3 - 17.5; median time since diagnosis: 5.7 yrs, 3.8 - 10.7 yrs). To avoid any bias from additional therapy elements, patients with relapse or initial CNS involvement and transplanted patients were excluded (n=32). Our cohort was representative of the total group of 104 long term survivors of study AML-BFM 87. CNS prophylaxis consisted of ARA-C i.th., high dose ARA-C i. v. and either no CRT (n=15) or CRT (n=38) at a dose of 12 - 18 Gy depending on age.
Methods:
Neuropsychological function was evaluated by psychological tests of attention and concentration (test d2 by Brickenkamp) and an intelligence test (Progressive Matrices by Raven). In addition, patients and their parents were interviewed about the occurrence of learning problems, subjective deficits in concentration and physical impairment.
Results:
In the total group, no significant differences were seen between irradiated and non-irradiated patients regarding the psychological tests. However, the irradiated patients scored below the non-irradiated control group in test "d2" (concentration: 41st vs. 59th percentile). In the interview, irradiated patients tended to report more learning problems (lp) (10/36 vs. 1/14; p=0.15) and subjective deficits in concentration (con). In irradiated girls (con: 6/15 vs. 0/8; p=0.06; lp: 5/15 vs. 0/8; p=0.12) and younger patients (0 - 5 years at diagnosis; con: 7/12 vs. 2/9; p=0.18; lp 3/10 vs. 1/9; p=0.18) this trend was even more pronounced.
Conclusion:
Children with AML and CRT had no significant intellectual impairment in standardized tests when compared to non-irradiated patients. However, more irradiated patients reported learning problems and subjective concentration deficits.
