Neuropsychological outcome following intensity-modulated radiation therapy for pediatric medulloblastoma

Background. Combined cisplatin chemotherapy and cranial irradiation for treatment of medulloblastoma in children can cause significant ototoxicity and impair cognitive function and quality of life. We have previously demonstrated the conformal technique of intensity-modulated radiation therapy (IMRT) to reduce ototoxicity, however, it has been suggested that IMRT may increase risk of cognitive deficits compared to conventional radiation therapy (CRT). This study compared the impact of the two treatments on measures of neurocognitive functioning. Procedure. Twenty-five pediatric patients with medulloblastoma were treated either with CRT or IMRT. In addition they received neurocognitive assessments to evaluate long-term functional outcome. Statistical analyses between the two groups were conducted to compare levels and profiles of performance on tests not confounded with hearing loss. Results. When compared to CRT, children treated with IMRT did not perform more poorly on any of the measures. Both groups' mean performance was significantly lower than published norms on several of the measures employed. Conclusion. The benefit of reduced ototoxicity with IMRT does not appear to be at the cost of a decline in nonverbal intellectual abilities, visual-spatial skills, processing speed, or fine motor dexterity when compared to CRT in children with medulloblastoma.