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AcknowledgmentsThe authors wish to thank the participant families and the PNET4 committee and all the PNET 4 investigators. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT SummaryCognitive performance (Intelligence Quotient) in children and young adults with standard risk medulloblastoma in the XXXXX randomised controlled treatment trial were compared between those allocated to hyperfractionated (HFRT arm) or standard radiation therapy (STRT arm), followed, in both treatment arms, by a standard chemotherapy regimen. Treatment with HFRT was associated with a trend towards better verbal outcomes in children aged less than 8 years at diagnosis, but no significant differences on the other cognitive measures. M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPTCognitive performance in the XXXXX study 1 Abstract Purpose/Objective(s): In the XXX-XXXX XXXXX European randomised controlled trial, children with standard risk medulloblastoma were allocated to hyperfractionated (HFRT arm, including a partially focussed boost) or standard radiation therapy (STRT arm) followed, in both arms, by maintenance chemotherapy. Event-free survival was similar in both arms. Previous work showed that HFRT arm was associated with worse growth and better questionnaire-based executive function, especially in children aged <8 years at diagnosis. Therefore, the aim of this study was to compare performance-based cognitive outcomes between treatment arms. Methods and Conclusions:HFRT arm was associated with marginally higher VIQ in children aged <8 years at diagnosis, consistent with the previous report using questionnaire-based data. However, overall cognitive ability was not significantly different.