Cognitive and Adaptive Outcomes Following Proton Radiation for Pediatric Patients with Brain Tumors
Menée auprès de 155 patients pédiatriques atteints d'une tumeur cérébrale (âge moyen : 8,9 ans), cette étude évalue, en fonction de l'âge des patients, l'effet d'une protonthérapie sur les capacités cognitives et d'adaptation
Purpose : Radiation therapy is integral in treatment of pediatric brain tumors, but is associated with negative long-term sequelae. Proton radiotherapy (PRT), which enables better focusing of radiation to tumors, may entail fewer sequelae. This prospective study examined cognitive and adaptive functioning in children and young adults treated with PRT. Methods and Materials : 155 patients were assessed using age-appropriate measures for cognitive and adaptive functioning at start of or during PRT (baseline) and follow-up. Mean age at baseline was 8.9 years; mean follow-up interval was 3.6 years. Diagnoses included medulloblastoma, craniopharyngioma, ependymoma, glial, germ cell, and others. The sample was divided by age at baseline: <6 years (37%) and ≥6 years (63%), and by PRT field: craniospinal irradiation (CSI) (39%) and focal irradiation (61%). Results : Mean IQ and adaptive scores were in the average range at baseline and follow-up. Overall, mean IQ declined from 105.4 to 102.5 (P = 0.005); however, only the younger/CSI group showed significant decline. CSI patients, regardless of age, appeared particularly vulnerable in IQ, processing speed, and working memory. Adaptive skills were stable across the four age-by-treatment field groups. Conclusions : At a mean of 3.6 years after PRT, IQ declined slightly for the group, largely due to significant IQ decline in younger patients treated with CSI. No significant change was seen in patients <6 years treated with focal PRT or in older patients. Adaptive skills remained stable across age and treatment type.