Longitudinal Investigation of Adaptive Functioning Following Conformal Irradiation for Pediatric Craniopharyngioma and Low-Grade Glioma

Abstract

Purpose Children treated for brain tumors with conformal radiation therapy experience preserved cognitive outcomes. Early evidence suggests that adaptive functions or independent living skills may be spared. This longitudinal investigation prospectively examined intellectual and adaptive functioning during the first 5 years following irradiation for childhood craniopharyngioma and low-grade glioma (LGG). The effect of visual impairment on adaptive outcomes was investigated. Methods and Materials Children with craniopharyngioma (n=62) and LGG (n=77) were treated using conformal or intensity-modulated radiation therapy. The median age was 8.05 years (3.21 years –17.64 years) and 8.09 years (2.20 years–19.27 years), respectively. Serial cognitive evaluations including measures of intelligence quotient (IQ) and the Vineland Adaptive Behavior Scales (VABS) were conducted at pre-irradiation baseline, 6 months after treatment, and annually through 5 years. A total of 588 evaluations were completed during the follow-up period. Results Baseline assessment revealed no deficits in IQ and VABS indices for children with craniopharyngioma, with significant (p < .05) longitudinal decline in VABS Communication and Socialization indices. Clinical factors associated with more rapid decline included females and pre-irradiation chemotherapy (interferon). The only change in VABS Daily Living Skills correlated with IQ change (r = .34; p = .01) in children with craniopharyngioma. Children with LGG performed below population norms (p < .05) at baseline on VABS Communication, Daily Living Indices, and the Adaptive Behavior Composite, with significant (p < .05) longitudinal decline limited to VABS Communication. Older age at irradiation was a protective factor against longitudinal decline. Severe visual impairment did not independently correlate with poorer adaptive outcomes for either tumor group. Conclusions There was relative sparing of post-irradiation functional outcomes over time in this sample. Baseline differences in functional abilities prior to the initiation of irradiation suggested that other factors influence functional outcomes above and beyond the effects of irradiation.

Executive dysfunction is associated with poorer health-related quality of life in pediatric brain tumor survivors

“…Mean IQ and BRIEF scores were within the average range, indicating some preservation of function following CRT, which is consistent with prior findings (Netson, Conklin, Wu, Xiong & Merchant, 2013; Netson, Conklin, Wu, Xiong & Merchant, 2012; Conklin et al, 2008). IQ was not directly correlated with parent- or child-reported HRQoL.…”

“…This method has the potential to improve functional outcomes, although some cognitive functions may still be vulnerable (Conklin et al, 2008; Netson et al, 2012; Conklin et al 2012; Netson et al, 2013). While multiple studies have examined HRQoL after conventional radiation therapy, proton beam radiation therapy, chemotherapy, and other treatment modalities (Reimers et al, 2009; Laffond et al, 2012; Benesch et al, 2009), no known studies have examined HRQoL after CRT for pediatric brain tumor.…”

Proton Beam Therapy Versus Conformal Photon Radiation Therapy for Childhood Craniopharyngioma: Multi-institutional Analysis of Outcomes, Cyst Dynamics, and Toxicity

“…Two previous reports suggested that patients treated for craniopharyngioma did not have significant long-term changes in IQ, daily living skills, or self-reported quality of life indicators. 26,31 . Future studies including the use of formal neurocognitive testing are warranted and ongoing.…”

Cumulative neurological factors associated with long-term outcomes in adult survivors of childhood brain tumors

“…Longitudinal studies have reported that these children are acquiring intellectual and adaptive skills at a slower rate relative to their same age peers but are not losing skills over time (Netson, Conklin, Wu, Xiong, & Merchant, 2013;Palmer et al, 2001). By the time individuals are reaching adulthood, there are increased demands on and expectations of rapid development of cognitive abilities and independent living skills, but young adult survivors may experience more significant impairments relative to peers who are gaining these skills.…”