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

Mahajan, Anita; Stavinoha, Peter L.; Rongthong, Warissara; Brodin, N. Patrik; McGovern, Susan L.; Naqa, Issam El; Palmer, Joshua D.; Vennarini, Sabina; Indelicato, Daniel J.; Aridgides, Paul; Bowers, Daniel C.; Kremer, Leontien C. M.; Ronckers, Cecile; Constine, Louis S.; Avanzo, Michele

doi:10.1016/j.ijrobp.2020.11.073

Cited by 40 publications

(30 citation statements)

References 130 publications

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“…Therefore, the use of proton therapy may reduce the impact on cognition and development. The PENTEC initiative has published modeling of this risk and continues to refine risk predictions for neurocognitive and other late effects of radiation [ 68 ].…”

Section: Resultsmentioning

confidence: 99%

Radiation Therapy in the Treatment of Head and Neck Rhabdomyosarcoma

Frankart

Breneman

Pater

2021

Cancers

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The use of radiation therapy is an important part of multimodality treatment for rhabdomyosarcoma. The specific doses, treatment volumes, and techniques used in radiation therapy can vary dramatically based upon a number of factors including location, tumor size, and molecular characteristics, resulting in complex decisions in treatment planning. This article reviews the principles of evaluation and management for head and neck rhabdomyosarcoma including a summary of the historical studies upon which current management is based.

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Section: Resultsmentioning

confidence: 99%

Radiation Therapy in the Treatment of Head and Neck Rhabdomyosarcoma

Frankart

Breneman

Pater

2021

Cancers

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“…Essential treatment modalities also pose risk to neurocognitive functions, thereby impacting educational performance and attainment. Cranial radiation therapy (CRT) is often identified as the most impactful and deleterious treatment-related risk factor to neurocognitive outcomes for PBT survivors due to white matter changes that associate with neurocognitive dysfunction and persisting late effects [ 21 ]. Chemotherapy, while thought to be less toxic relative to radiation treatment, has been associated with cognitive impairment [ 22 , 23 ], as well as hearing impairments [ 24 ] thus, magnifying the functional impact of neurocognitive late effects.…”

Section: Educational Pain Points For Pediatric Brain Tumor Survivorsmentioning

confidence: 99%

“…Historically, overall IQ has been a frequently cited vulnerability following treatment for PBT [ 21 , 29 , 30 ]. Recent evidence suggests that these overall declines may be better accounted for by specific cognitive abilities that both support overall intellectual ability and are at risk due to PBT, treatment, and associated complications [ 31 ].…”

Section: Educational Pain Points For Pediatric Brain Tumor Survivorsmentioning

confidence: 99%

“…Recent evidence suggests that these overall declines may be better accounted for by specific cognitive abilities that both support overall intellectual ability and are at risk due to PBT, treatment, and associated complications [ 31 ]. For example, core deficits most commonly reported following treatment for PBT include attention, working memory, and processing speed, functions which may decline over time [ 21 , 32 , 33 , 34 , 35 ].…”

Section: Educational Pain Points For Pediatric Brain Tumor Survivorsmentioning

confidence: 99%

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Educational Pain Points for Pediatric Brain Tumor Survivors: Review of Risks and Remedies

et al. 2021

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Evolving treatment paradigms have led to increased survival rates for children diagnosed with a brain tumor, and this has increasingly shifted clinical and research focus to morbidity and quality of life among survivors. Among unfavorable outcomes, survivors of pediatric brain tumors are at risk for academic failure and low educational attainment, which may then contribute to lower health related quality of life, lower income and vocational status, and a greater likelihood of dependence on others in adulthood. Several specific risk factors for lower educational performance and attainment have been investigated. These are typically examined in isolation from one another which clouds understanding of the full range and potential interplay of contributors to educational difficulties. This review integrates and summarizes what is known about the direct and indirect barriers to educational success and performance (i.e., educational pain points) to enhance clinician knowledge of factors to consider when working with pediatric brain tumor survivors. Specific barriers to educational success include neurocognitive difficulties, school absences, psychosocial challenges, challenges to knowledge and communication, and physical and sensory difficulties. Finally, we discuss the current state of educational interventions and supports and offer recommendations for future research to improve educational outcomes for pediatric brain tumor survivors.

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“…However, many studies did not find any improvement for cognitive effects, potentially also because of interactive effects of increased doses of methotrexate in many studies ( 176 , 177 ). A recent mathematical model from the Paediatric Normal Tissue Effects in the Clinic (PENTEC) international consortium calculated the detrimental interaction between cranial radiotherapy and administrated methotrexate with regard to the risk of intelligence quotient (IQ) decrease after treatment and generated dose- and other risk-factor-related normal tissue complication probability models ( 178 ). The risk of an IQ <85 was 5% for children who had received a whole-brain dose of radiotherapy of 18.1 Gy, and methotrexate increased any risk of an IQ <85 in equivalence to a generalised uniform brain dose of 5.9 Gy.…”

Section: Long-term Neurotoxicity Post Hsctmentioning

confidence: 99%

A Review of Acute and Long-Term Neurological Complications Following Haematopoietic Stem Cell Transplant for Paediatric Acute Lymphoblastic Leukaemia

et al. 2021

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Despite advances in haematopoietic stem cell transplant (HSCT) techniques, the risk of serious side effects and complications still exists. Neurological complications, both acute and long term, are common following HSCT and contribute to significant morbidity and mortality. The aetiology of neurotoxicity includes infections and a wide variety of non-infectious causes such as drug toxicities, metabolic abnormalities, irradiation, vascular and immunologic events and the leukaemia itself. The majority of the literature on this subject is focussed on adults. The impact of the combination of neurotoxic drugs given before and during HSCT, radiotherapy and neurological complications on the developing and vulnerable paediatric and adolescent brain remains unclear. Moreover, the age-related sensitivity of the nervous system to toxic insults is still being investigated. In this article, we review current evidence regarding neurotoxicity following HSCT for acute lymphoblastic leukaemia in childhood. We focus on acute and long-term impacts. Understanding the aetiology and long-term sequelae of neurological complications in children is particularly important in the current era of immunotherapy for acute lymphoblastic leukaemia (such as chimeric antigen receptor T cells and bi-specific T-cell engager antibodies), which have well-known and common neurological side effects and may represent a future treatment modality for at least a fraction of HSCT-recipients.

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

Cited by 40 publications

References 130 publications

Radiation Therapy in the Treatment of Head and Neck Rhabdomyosarcoma

Radiation Therapy in the Treatment of Head and Neck Rhabdomyosarcoma

Educational Pain Points for Pediatric Brain Tumor Survivors: Review of Risks and Remedies

A Review of Acute and Long-Term Neurological Complications Following Haematopoietic Stem Cell Transplant for Paediatric Acute Lymphoblastic Leukaemia

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