Intellectual functioning among case-matched cohorts of children treated with proton or photon radiation for standard-risk medulloblastoma.

Abstract

BACKGROUND:

Proton therapy may reduce cognitive deficits after radiotherapy among brain tumor survivors, although current data are limited to retrospective comparisons between historical cohorts. The authors compared intelligence quotient scores within a case-matched cohort of children with medulloblastoma treated with proton radiation (PRT) or photon radiation (XRT) over the same time period.

METHODS:

Among 88 consecutive patients with standard-risk medulloblastoma treated with PRT or XRT at 2 institutions from 2000 to 2009, 50 were matched 1:1 (25 with PRT and 25 with XRT) according to age, gender, date of diagnosis, histology, radiation boost, and craniospinal irradiation dose. One-way analyses of variance were performed to compare the Full-Scale Intelligence Quotient (FSIQ) and associated index scores between the 2 cohorts.

RESULTS:

Neurocognitive data were available for 37 survivors (17 with PRT and 20 with XRT) from the matched cohort. The mean age was 8.5 years (SD, 4.14 years). The median follow-up was 5.3 years (range, 1.0-11.4 years) and 4.6 years (range, 1.1-11.2 years) for the PRT and XRT cohorts, respectively (P = .193). Patients treated with PRT had significantly higher mean FSIQ (99.6 vs 86.2; P = .021), verbal (105.2 vs 88.6; P = .010), and nonverbal scores (103.1 vs 88.9; P = .011) than the XRT-treated cohort. Differences in processing speed (82.9 vs 77.2; P = .331) and working memory (97.0 vs 92.7; P = .388) were not statistically significant.

CONCLUSIONS:

Radiotherapy-associated cognitive effects appear to be more attenuated after proton therapy. Comprehensive prospective studies are needed to appropriately evaluate the neurocognitive advantages of proton therapy.

• Authors: Bree R Eaton, Grace W Fong, Lisa M Ingerski, Margaret B Pulsifer, Subir Goyal, Chao Zhang, Elizabeth A Weyman, Natia Esiashvili, James L Klosky, Tobey J MacDonald, David H Ebb, Shannon M MacDonald, Nancy J Tarbell, Torunn I Yock
• Journal: Cancer (Cancer) Vol. 127 Issue 20 Pg. 3840-3846 (10 15 2021) ISSN: 1097-0142 [Electronic] United States
• PMID: 34255345 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 American Cancer Society.

Chemical References

• Protons

Topics

• Cerebellar Neoplasms (radiotherapy)
• Child
• Cognition (radiation effects)
• Humans
• Medulloblastoma (radiotherapy)
• Proton Therapy (adverse effects)
• Protons
• Retrospective Studies