Prospective, longitudinal comparison of neurocognitive change in pediatric brain tumor patients treated with proton radiotherapy versus surgery only

Lisa S. Kahalley, M. Douglas Ris, Anita Mahajan, M. Fatih Okcu, Murali Chintagumpala, Arnold C. Paulino, William E. Whitehead, Charles G. Minard, Heather H. Stancel, Jessica Orobio, Judy J. Xue, Emily A. Warren, David R. Grosshans

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

Background. Proton radiotherapy (PRT) reduces the volume of normal tissue receiving radiation dose, which may lead to better neurocognitive outcomes. We examined change in neurocognitive scores over time in pediatric brain tumor patients treated with proton craniospinal irradiation (CSI), proton focal RT, or surgery only. Methods. Patients received annual neurocognitive evaluations for up to 6 years. We examined Full Scale IQ (FSIQ), Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Working Memory Index (WMI), and Processing Speed Index (PSI) scores. General linear mixed models examined change in scores over time by treatment group, adjusting for significant covariates. Results. Scores from 93 patients treated between 2012 and 2017 (22 proton CSI, 31 proton focal, and 40 surgery only) were examined. Treatment groups were similar on gender (51.6% male), age at treatment (median = 9.7 y), and length of follow-up (median = 2.9 y). The surgery only group had proportionately more gliomas (P 0.001), and the proton CSI group had more infratentorial tumors (P = 0.001) and higher total RT dose (P = 0.004). The proton focal and surgery only groups exhibited stable neurocognitive scores over time across all indexes (all P 0.05). In the proton CSI group, WMI, PSI, and FSIQ scores declined significantly (P = 0.036, 0.004, and 0.017, respectively), while VCI and PRI scores were stable (all P 0.05). Conclusions. Focal PRT was associated with stable neurocognitive functioning into survivorship. Outcomes were similar whether patients received focal PRT or no radiotherapy, even in neurocognitive domains known to be particularly radiosensitive. Proton CSI emerged as a neurocognitive risk factor, consistent with photon outcomes research.

Original languageEnglish (US)
Pages (from-to)809-818
Number of pages10
JournalNeuro-oncology
Volume21
Issue number6
DOIs
StatePublished - Jun 10 2019

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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