ID #966 Neurocognitive outcomes in patients with pediatric brain tumors treated with conformal photon radiotherapy
Archya Dasgupta, Savita Goswami, Lekhika Sonkusare, Akanksha Rao, Akshay Dineshan, Abhishek Chatterjee, Siddharth Haldurai, Maya Prasad, Venkata Rama, Mohan Gollamudi, Arpita Sahu, Epari Sridhar, Girish Chinnaswamy, Tejpal GuptaAbstract
Background
Radiotherapy plays an integral role in the management of several pediatric brain tumors, improving survival. Neurocognitive function can be affected by radiotherapy in survivors, which is often multifactorial, including primary disease as well as other treatment modalities contributing to decline. We present real-world data of neurocognitive function of a large cohort of pediatric patients treated with radiotherapy.
Methods
The retrospective study included patients aged < 18 years treated with conformal radiotherapy, and neurocognitive evaluation was done before starting radiation, with a proportion of patients having follow-up evaluation. Patients were treated with image-guided photon radiotherapy between 2010 and 2023. Neurocognitive evaluation was done using the age-appropriate Wechsler Intelligence Scale for Children (WISC). Whenever feasible, follow up evaluation was done on an annual basis post-radiotherapy.
Results
Pre-radiotherapy evaluation was available in 289 patients with common histologies being medulloblastoma (73), posterior fossa ependymoma (65), craniopharyngioma (65), optic pathway glioma (42), and germ cell tumor (22). Supratentorial location was seen in 59%, and low-grade or benign histology in 57% of patients. Deficits in Full Scale Intelligence Quotient (FSIQ) were seen in 32%, with supratentorial tumors and midline location serving as independent risk factors. The median FSIQ was 86 (IQR 73-101), and domains in Performance Quotient were more affected than Verbal Quotient. Two-year follow-up was available in 85 patients with a median FSIQ of 87 (IQR 76-102). Five-year post-radiotherapy median FSIQ was 91 (IQR 71-104) as available from 51 patients.
Conclusion
One third of patients had pre-radiation deficits, with disease location serving as a major risk factor. Conformal image-guided photon radiotherapy led to preservation of neurocognition in patients, with modern techniques like proton beam therapy offering further scope of improving neurocognitive function.