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Cognitive and Adaptive Outcomes After Proton Radiation for Pediatric Patients With Brain Tumors

Margaret B Pulsifer1, Haley Duncanson1, Julie Grieco1

  • 1Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.

International Journal of Radiation Oncology, Biology, Physics
|August 16, 2018
PubMed

Insights

Proton beam radiation therapy (PRT) for pediatric brain tumors showed stable adaptive skills. Younger patients receiving craniospinal irradiation (CSI) experienced significant IQ decline, while others showed minimal changes.

Area of Science:

  • Pediatric Oncology
  • Radiation Oncology
  • Neuroscience

Background:

  • Radiation therapy is crucial for pediatric brain tumors but can cause long-term side effects.
  • Proton beam radiation therapy (PRT) offers precise targeting, potentially reducing sequelae.
  • Understanding the neurocognitive and adaptive outcomes of PRT is essential for long-term patient care.

Purpose of the Study:

  • To prospectively evaluate the cognitive and adaptive functioning of pediatric and young adult patients treated with PRT.
  • To identify specific patient groups or treatment parameters associated with differential outcomes.

Main Methods:

  • 155 patients treated with PRT were assessed at baseline and follow-up (mean 3.6 years).
  • Assessments included age-appropriate measures of intelligence quotient (IQ) and adaptive functioning.
  • Patients were stratified by age at baseline (<6 years vs. ≥6 years) and PRT field (craniospinal irradiation [CSI] vs. focal irradiation).

Main Results:

  • Mean IQ and adaptive functioning scores remained in the average range at baseline and follow-up.
  • Overall mean IQ showed a slight decline (105.4 to 102.5, P=.005).
  • Younger patients (<6 years) receiving CSI demonstrated a significant decline in IQ, processing speed, and working memory. Adaptive skills were stable across all groups.

Conclusions:

  • PRT resulted in stable adaptive functioning in pediatric brain tumor patients.
  • Younger patients treated with CSI are particularly vulnerable to IQ decline.
  • Focal PRT did not significantly impact IQ in younger patients, and older patients showed no significant changes, suggesting treatment modality and age are critical factors.
Abstract

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