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Comparative Study
. 2019 Jul 11;21(7):934-943.
doi: 10.1093/neuonc/noz070.

Improved neuropsychological outcomes following proton therapy relative to X-ray therapy for pediatric brain tumor patients

Jeffrey P Gross  1 , Stephanie Powell  2 , Frank Zelko  2 , William Hartsell  1   3   4 , Stewart Goldman  5 , Jason Fangusaro  6 , Rishi R Lulla  7 , Natasha Pillay Smiley  5 , John Han-Chih Chang  8 , Vinai Gondi  1   3   4
Affiliations
Comparative Study

Improved neuropsychological outcomes following proton therapy relative to X-ray therapy for pediatric brain tumor patients

Jeffrey P Gross et al. Neuro Oncol. .

Abstract

Background: Survivors of pediatric brain tumors are at risk for impaired development in multiple neuropsychological domains. The purpose of this study was to compare neuropsychological outcomes of pediatric brain tumor patients who underwent X-ray radiotherapy (XRT) versus proton radiotherapy (PRT).

Methods: Pediatric patients who underwent either XRT or PRT and received posttreatment age-appropriate neuropsychological evaluation-including measures of intelligence (IQ), attention, memory, visuographic skills, academic skills, and parent-reported adaptive functioning-were identified. Multivariate analyses were performed to assess differences in neuropsychological outcomes and included tests for interaction between treatment cohort and follow-up time.

Results: Between 1998 and 2017, 125 patients with tumors located in the supratentorial (17.6%), midline (28.8%), or posterior fossa (53.6%) compartments received radiation and had posttreatment neuropsychological evaluation. Median age at treatment was 7.4 years. The PRT patient cohort had higher estimated SES and shorter median time from radiotherapy completion to last neuropsychological evaluation (6.7 vs 2.6 y, P < 0.001). On multivariable analysis, PRT was associated with higher full-scale IQ (β = 10.6, P = 0.048) and processing speed (β = 14.4, P = 0.007) relative to XRT, with trend toward higher verbal IQ (β = 9.9, P = 0.06) and general adaptive functioning (β = 11.4, P = 0.07). Planned sensitivity analyses truncating follow-up interval in the XRT cohort re-demonstrated higher verbal IQ (P = 0.01) and IQ (P = 0.04) following PRT, with trend toward improved processing speed (P = 0.09).

Conclusions: PRT is associated with favorable outcomes for intelligence and processing speed. Combined with other strategies for treatment de-intensification, PRT may further reduce neuropsychological morbidity of brain tumor treatment.

Keywords: neuropsychologic outcomes; pediatrics; proton therapy; radiotherapy.

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References

    1. Hirsch JF, Renier D, Czernichow P, Benveniste L, Pierre-Kahn A. Medulloblastoma in childhood. Survival and functional results. Acta Neurochir (Wien). 1979;48(1-2):1–15. - PubMed
    1. King AA, Seidel K, Di C, et al. . Long-term neurologic health and psychosocial function of adult survivors of childhood medulloblastoma/PNET: a report from the Childhood Cancer Survivor Study. Neuro Oncol. 2017;19(5):689–698. - PMC - PubMed
    1. Frange P, Alapetite C, Gaboriaud G, et al. . From childhood to adulthood: long-term outcome of medulloblastoma patients. The Institut Curie experience (1980-2000). J Neurooncol. 2009;95(2):271–279. - PubMed
    1. Gurney JG, Krull KR, Kadan-Lottick N, et al. . Social outcomes in the Childhood Cancer Survivor Study cohort. J Clin Oncol. 2009;27(14):2390–2395. - PMC - PubMed
    1. Armstrong GT, Liu Q, Yasui Y, et al. . Long-term outcomes among adult survivors of childhood central nervous system malignancies in the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2009;101(13):946–958. - PMC - PubMed

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