SS 14 - Pediatrics 2
103 - Neuropsychological Outcomes of Pediatric Brain Tumor Patients Treated With Proton (PRT) or X-ray (XRT) Radiation Therapy
Monday, October 22
11:25 AM - 11:35 AM
Location: Room 008
Jeffrey Gross, MD, MS
McGaw Medical Center of Northwestern University: Resident physician: Employee
Neuropsychological Outcomes of Pediatric Brain Tumor Patients Treated With Proton (PRT) or X-ray (XRT) Radiation Therapy
J. Gross1, S. Powell2, F. Zelko2, W. F. Hartsell3, S. Goldman2, J. Fangusaro2, R. Lulla2, N. Pillay Smiley2, J. H. C. Chang3, and V. Gondi4; 1Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, 2Lurie Children’s Hospital of Chicago, Chicago, IL, 3Northwestern Medicine Chicago Proton Center, Warrenville, IL, 4Northwestern Medicine Chicago Proton Center and Northwestern Medicine Cancer Center Warrenville, Warrenville, IL
Purpose/Objective(s): To compare neuropsychological outcomes following PRT versus XRT for pediatric brain tumors.
Materials/Methods: 125 patients received treatment for tumors located in the supratentorial (17.6%), midline (28.8%) or posterior fossa (53.6%) compartments. All received age-appropriate neuropsychological assessment of intelligence quotient (IQ), processing speed (PS), visual motor integration (VMI), executive function, memory and parent-reported function at a single institution. Tests of IQ, PS, VMI and parent-reported functioning were standardized with mean of 100 and standard deviation of 15. Tests of digit and memory were scaled with mean of 10 and standard deviation of 3. Univariate and multivariate linear regression analyses were used to assess predictors of neuropsychological outcomes.
Results: Median age at diagnosis was 7.0 years; median time from treatment to last assessment was 4.0 years. Patients receiving PRT had higher socioeconomic status (SES), differing distributions of race and tumor locations, and shorter median time from treatment conclusion to last neuropsychological assessment compared to XRT (2.6 vs. 6.6 years, p<0.001). On univariate analyses, patients receiving PRT had higher mean verbal IQ (99.6 vs. 92.9, p=0.03), full-scale IQ (99.6 vs. 88.6, p=0.02), PS (86.9 vs. 80.0, p=0.03), VMI (87.1 vs. 80.8, p=0.04), general adaptive composite (91.4 vs. 80.7, p=0.04), conceptual function (94.6 vs. 84.1, p=0.002), social function (94.8 vs. 86.2, p=0.002), and practical function (91.1 vs. 78.9, p=0.002). There were no significant differences in digit span or long-term memory. Multivariate analyses including test for interaction with follow-up time identified higher full-scale IQ (β=10.6 points/year, p=0.048), PS (β=12.6, p=0.02), and parent-reported practical function (β=13.8, p=0.049) following PRT relative to XRT; lower PS (β=-15.9, p=0.04) and VMI (β=-14.0, p=0.006) following craniospinal irradiation (CSI); and higher verbal IQ (β=0.84, p=0.02) and full-scale IQ (β=1.03, p=0.01) for older patients. VMI was higher in those with higher SES (β=1.2 points/$10,000 household income, p=0.04), but lower following receipt of vincristine chemotherapy (β=-16.6, p=0.01). Parent-reported practical function was lower in those with posterior fossa tumors (β=-10.8, p=0.048). Subgroup analyses demonstrated that treatment with PRT, relative to XRT, was associated with higher full-scale IQ (β=17.2, p=0.02) following CSI or whole ventricular RT (n=76) and higher PS (β=22.6, p=0.01) following partial brain RT (n=49).
Conclusion: In terms of full-scale IQ, processing speed, and parent-reported practical function, favorable neuropsychological outcomes are observed following PRT relative to XRT, with differences in full-scale IQ noted in patients receiving CSI or whole-ventricular RT and differences in processing speed noted in patients receiving partial brain RT.
Author Disclosure: J. Gross: None. S. Powell: None. W.F. Hartsell: Partner; Radiation Oncology Consultants, Ltd. Minority owner of GammaKnife equipment; Elk Grove Radiosurgery Inc. Partnership; Elk Grove Radiosurgery Inc, Illinois Cyberknife. Medical Director; Chicago Proton Center. S. Goldman: None. J. Fangusaro: None. N. Pillay Smiley: None. J. Chang: Partner; Radiation Oncology Consultants, Ltd. Assistant Professorship; Chicago Medical School. Stock; Chicago Proton Therapy, Inc, ROC Cyberknife Investment, LLC, Elk Grove Radiosurgery, Inc. Board Member; Chicago Proton Therapy, Inc. V. Gondi: Partner; Radiation Oncology Consultants, Ltd. Partnership; Radiation Oncology Consultants, Ltd.