Cognitive mediators of adaptive functioning outcomes in survivors of pediatric brain tumors treated with proton radiotherapy

Abstract

Background: Cranial radiotherapy (RT) is associated with risk for cognitive and adaptive dysfunction. Proton RT (PRT) is a technique hypothesized to spare cognition by reducing exposure to non-target brain tissue. However, little is known regarding functional outcomes in survivors of pediatric brain tumor (BT) treated with PRT. The present study examined the relationship between cognitive and adaptive outcomes in pediatric BT survivors post-PRT.Methods: Survivors treated with either focal (n = 33) or craniospinal (CSI; n = 37) PRT completed neurocognitive evaluations approximately 5 years post-treatment. Results of intelligence testing and ratings of adaptive functioning are reported. Mediation models examined the relationship among radiation field, cognition, and adaptive functioning. Results:The PRT CSI group demonstrated worse cognitive outcomes than the PRT Focal group across each cognitive index (Cohen's d = .56 to .70). Parent ratings of adaptive functioning were also worse in the PRT CSI group than the PRT Focal group (Global Adaptive Composite, d = .53; Conceptual skills, d = .67). Cognitive performance fully mediated the relationship between radiation field and adaptive outcomes, while controlling for group differences in tumor histology and RT dose. Conclusions:Focal PRT survivors demonstrated generally positive outcomes with weaknesses in processing speed and aspects of adaptive functioning. CSI exposure was associated with more

Neurocognitive Effects and Necrosis in Childhood Cancer Survivors Treated With Radiation Therapy: A PENTEC Comprehensive Review

“…20,21 In a recent report, PRT was associated with more favorable outcomes (compared with XRT) in most neurocognitive domains in children with medulloblastoma. 22,23 In addition to the dose and volume dependence previously noted, RT doses to specific regions of the brain, particularly the temporal lobes and hippocampi, may disproportionally affect long-term IQ and academic performance. 16,24,25 RT-induced injury of the brain's white matter may partially explain these cognitive changes as magnetic resonance imaging (MRI) studies have correlated a decline in cognitive ability with white matter loss.…”

Psychosocial and Executive Functioning Outcomes in Pediatric Brain Tumor Survivors After Proton Radiation

“…1 Radiation treatment is a life-saving intervention that can be associated with neurocognitive, emotional, and behavioral sequalae, [2][3][4][5][6][7] although the use of proton radiation treatment (PRT) has yielded more favorable outcomes due to its dose-sparing properties. [8][9][10] Many studies examining the outcomes of PRT revealed cognitive and adaptive functioning in the normal range more than 3 years post-treatment; [11][12][13] however, adaptive functioning challenges at 5 years post-PRT have been observed, with greater vulnerability in survivors treated with craniospinal irradiation (CSI). 12 Studies of psychosocial and executive functioning outcome following PRT in pediatric brain tumor survivors are relatively recent, and require replication to strategically guide intervention.…”

“…[8][9][10] Many studies examining the outcomes of PRT revealed cognitive and adaptive functioning in the normal range more than 3 years post-treatment; [11][12][13] however, adaptive functioning challenges at 5 years post-PRT have been observed, with greater vulnerability in survivors treated with craniospinal irradiation (CSI). 12 Studies of psychosocial and executive functioning outcome following PRT in pediatric brain tumor survivors are relatively recent, and require replication to strategically guide intervention. Challenges with social functioning have been described, 14 most notably in aspects of peer exclusion and isolation.…”

“…19,35 Several specific risk factors may lead to adverse outcomes for pediatric brain tumor survivors. Younger age at diagnosis and treatment is a high risk factor for greater neurocognitive, 12,13,22 emotional, and behavioral 22,37 sequalae. The extent of radiation (CSI vs. focal) also impacts cognitive outcomes, 12,13,38 including executive functioning.…”

Processing Speed and Time since Diagnosis Predict Adaptive Functioning Measured with WeeFIM in Pediatric Brain Tumor Survivors

“…A growing body of evidence suggests that cognitive skills may act as mediators between clinical variables and AF in pediatric patients with acquired brain injury (ABI) [ 7 , 11 , 12 , 13 ], but research on the cognitive predictors of AF in pediatric BT patients is scarce.…”