Prospective longitudinal evaluation of emotional and behavioral functioning in pediatric patients with low-grade glioma treated with conformal radiation therapy

Abstract

Background Patients with low-grade glioma (LGG) who are successfully treated with irradiation are at increased risk for cognitive and psychosocial late effects. Conformal radiation therapy (CRT) allows sparing of cognitive deficits, but how it affects emotional and behavioral functioning remains unclear. We performed a prospective longitudinal study of the emotional and behavioral functioning of pediatric patients with LGG in the first 5 years post-CRT. Methods Ninety-five pediatric patients with LGG treated on an institutional Phase II trial (August 1997– June 2009) underwent neuropsychological assessments pre-CRT and 6, 12, 24, 36, 48, and 60 months post-CRT. Parent-reported scores on the Child Behavior Checklist (CBCL) were analyzed. Three competence scales (School Competence, Social Competence, and Activities), 2 summary scales (Internalizing Problems and Externalizing Problems), and 2 subscales of theoretical interest (Attention Problems and Social Problems) from the CBCL were used. Results Among 80 eligible patients [44 female, 68 white], 51 had pilocytic astrocytoma and 13 had optic pathway glioma. Mean age at diagnosis was 6.8 years (SD=4.3 years) and at CRT initiation was 8.9 years (SD=3.4 years). Before CRT, deficits were demonstrated on the competence scales (mean scores below normative mean) and the Attention Problems and Social Problems subscales (mean scores above normative means). This trend continued at 5 years post-CRT. Longitudinal trajectories of emotional and behavioral functioning were stable over 5 years. Conclusions Emotional and behavioral deficits remain relatively stable over the 5 years post-CRT in patients with LGG, suggesting that CRT may not exacerbate pre-existing psychosocial difficulties in this population.

Conformal Radiation Therapy for Pediatric Patients with Low-Grade Glioma: Results from the Children's Oncology Group Phase 2 Study ACNS0221

“…Merchant et al conducted prospective analyses of longterm toxicities in their patients. 11,17,[27][28][29] Children irradiated at less than 5 years of age had significantly increased risks of vasculopathy 11 and cognitive decline. 17 There was no overall decrease in learning ability after CRT, 28 but those given preirradiation chemotherapy were less able to learn new material.…”

“…17 Deficits in emotional and behavioral functioning were present before patients received CRT but remained stable through 5 years of follow up. 29 Adaptive functioning was also relatively spared. 30 Paulino et al investigated the use of IMRT in 39 patients with PLGG using 3 methods of target delineation: CTV Z GTV þ 1 cm, CTV Z GTV þ 0.5 cm, and dose painting (a lower dose given to a margin around the GTV).…”

Long-term visual outcomes of optic pathway gliomas in pediatric patients without neurofibromatosis type 1

“…Fisher et bilateral vision loss. Of note, 53 % of the patients in the study received radiotherapy, which is no longer considered first line therapy at our institution due to the secondary effects of radiation [12].…”

Predicting changes in adaptive functioning and behavioral adjustment following treatment for a pediatric brain tumor: A report from the Brain Radiation Investigative Study Consortium

“…Although several studies have delineated the difficulties children may face after diagnosis and moderators of risk, prospective longitudinal research remains rare. Existing research has noted more pronounced declines in behavioral functioning among those undergoing high‐risk treatment, females, and those with posterior fossa syndrome, with declines in communication and daily living skills for children examined at a younger age, females, and those with posterior fossa tumor location, subtotal resection, and receipt of chemotherapy . However, the relative importance of these factors as predictors of long‐term functioning remains underexplored, despite the potential to improve early identification of individuals at highest risk.…”