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. 2025 Jun 24;41(1):217.
doi: 10.1007/s00381-025-06876-4.

Neuropsychological outcome in pediatric brain tumor survivors treated with proton radiation prior to age 4 years

Tina Thomas  1   2 , Mary E Witt  3 , Casey L Evans  3   4 , Julie A Grieco  3   4 , Torunn I Yock  5   4 , Margaret B Pulsifer  3   4
Affiliations

Neuropsychological outcome in pediatric brain tumor survivors treated with proton radiation prior to age 4 years

Tina Thomas et al. Childs Nerv Syst. .

Abstract

Objective: Pediatric brain tumor survivors (PBTS) treated with radiation at a very young age are at risk for adverse neuropsychological outcomes. This retrospective cross-sectional study examined outcomes and educational service utilization in 45 PBTS treated with proton radiation therapy (PRT) before age 4.

Methods: PBTS and their parents were administered measures at ≥ 1 year post-PRT. Areas assessed: intelligence, emotional, behavioral, adaptive, and executive functioning. Age-based scores were compared to normative means, rates of impairment were calculated, and demographic/clinical factors and educational service utilization were examined.

Results: Median age at PRT was 2.58 years. Median interval to follow-up was 2.42 years. All received daily anesthesia during PRT and most received focal PRT (88.9%), had infratentorial tumors (71.1%), received chemotherapy (62.2%), and had sensory/motor deficits (51.1%). All mean standard/T-scores were in the average range. However, mean scores were significantly different from normative data and rates of impairment were notably elevated in withdrawal, anxiety, activities of daily living, shifting, working memory, and adaptive skills. Mean scores and rates of impairment were significantly lower (fewer problems) in aggression and conduct problems. Scores were comparable to the norm in attention, hyperactivity, depression, social skills, inhibition, and emotional control. More than half (62.2%) received special education services/accommodations; patients with sensory/motor deficits received more services/accommodations. Gender, tumor location, chemotherapy, and socioeconomic status were not significantly related to outcome.

Conclusion: Neuropsychological outcomes for PBTS treated with PRT before age 4 are encouraging, although there are some areas of concern. Yearly screening, proactive intervention for executive/psychological/adaptive functioning, and special education services/accommodations are recommended.

Keywords: Neuropsychological late effects of cancer treatment; Pediatric brain tumor; Proton radiation.

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Conflict of interest statement

Declarations. Conflict of interest: No actual or potential conflicts of interest exist for any author. Torunn Yock receives in kind research support from MIM software and serves on the Medical Advisory Committee for Mevion.

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