Related Experiment Video
Updated: Jun 14, 2025
Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
Published on: February 6, 2019
Psychosocial and executive functioning late effects in pediatric brain tumor survivors after proton radiation
Julie A Grieco1,2, Casey L Evans3,4, Torunn I Yock5,4
1Department of Psychiatry, Massachusetts General Hospital, Boston, USA. jagrieco@mgh.harvard.edu.
Insights
Pediatric brain tumor survivors treated with proton radiation therapy (PRT) showed average psychosocial and executive functioning within normal ranges. However, social withdrawal and metacognitive skills like working memory require targeted interventions.
Area of Science:
- Pediatric Oncology
- Neuropsychology
- Radiation Oncology
Background:
- Pediatric brain tumor survivors face potential long-term effects from radiation therapy.
- Proton radiation therapy (PRT) is used to treat pediatric brain tumors, but late effects require continued investigation.
- Understanding late psychosocial and executive functioning is crucial for comprehensive survivor care.
Purpose of the Study:
- To examine late psychosocial and executive functioning in pediatric patients treated with PRT at least 3 years post-treatment.
- To identify specific areas of concern in functioning for this survivor population.
Main Methods:
- A cross-sectional study of 101 pediatric brain tumor survivors.
- Parental completion of the Behavior Assessment System for Children and the Behavior Rating Inventory of Executive Function.
- Comparison of standard scores to normative means and calculation of impairment rates (T-score > 65).
Main Results:
- While overall functioning was within normal ranges, elevated T-scores were observed for social withdrawal, initiation, working memory, and planning/organizing.
- Significant impairment rates were noted in working memory (24.8%), initiation (20.4%), withdrawal (18.1%), and planning/organizing (17.0%).
- Social withdrawal was associated with craniospinal irradiation (CSI), chemotherapy, and hearing loss diagnosis. Hyperactivity and conduct problems were lower than norms.
Conclusions:
- Pediatric brain tumor survivors treated with PRT exhibit average psychosocial and executive functioning within normal limits.
- Specific concerns include social withdrawal and metacognitive executive functions (working memory, initiation, planning/organizing).
- Yearly screening and proactive interventions for executive skills and social functioning are recommended for this population.
Purpose:
Pediatric brain tumor survivors can experience detrimental effects from radiation treatment. This cross-sectional, large cohort study examined late psychosocial and executive functioning effects in pediatric patients treated ≥ 3 years after proton radiation therapy (PRT).
Methods:
Parents of 101 pediatric brain tumor survivors completed the Behavior Assessment System for Children and the Behavior Rating Inventory of Executive Function. Standard scores were compared to published normative means, rates of impairment (T-score > 65) were calculated, and demographic and clinical characteristics were examined.
Results:
Mean age at PRT was 8.12 years and mean interval from PRT to assessment was 6.05 years. Half were female (49.5%), 45.5% received craniospinal irradiation (CSI), and 58.4% were diagnosed with infratentorial tumors. All mean T-scores were within normal range. Mean T-scores were significantly elevated compared to the norm on the withdrawal, initiate, working memory, and plan/organize scales. Rates of impairment were notably high in working memory (24.8%), initiate (20.4%), withdrawal (18.1%), and plan/organize (17.0%). Greater withdrawal was significantly associated with CSI and also with chemotherapy and diagnosis of hearing loss. Mean T-scores were significantly lower than the norm on the hyperactivity, aggression, conduct problems, and inhibition scales. No significant problems were identified with social skills or depression. Interval since treatment was not correlated with any scale.
Conclusion:
Although psychosocial and executive functioning was within the normal range, on average, social withdrawal and metacognitive executive functioning (working memory, initiating, planning/organizing) were areas of concern. Targeted yearly screening and proactive executive skill and social interventions are needed for this population.
