paediatrics Brussels 17

Redmond et al.: Radiation to neural progenitor niches and neurocognitive outcomes

most commonly (87.5%) vincristine based. The neuro- psychological evaluation was completed by the follow- ing number of patients: baseline, n ¼ 13 (time between diagnosis and baseline testing: range 14–2284 days, median 127 days); 6-month follow-up, n ¼ 13; 15-month follow-up, n ¼ 14; 27-month follow-up, n ¼ 10; and by the following number of controls: baseline, n ¼ 55; 6-month follow-up, n ¼ 43; 15-month follow-up, n ¼ 38; 27-month follow-up, n ¼ 37. Fig. 2 shows overall changes in neuropsychological test scores over time in the patient and control groups, and Fig. 3 shows the differences in the mean test scores at in- dividual visits. The main LME analysis indicated that patients tended to have a significantly lower (worse) overall performance on motor dexterity (group, P ¼ .015; Group × Time, P ¼ .027), verbal learning (group, P ¼ .001; Group × Age 0 , P ¼ .003), visuospa- tial working memory (group–trend, P ¼ .057; Group × Age 0 , P ¼ .047; Group × Time, P ¼ .003), and visual perception (group, P , .0001; Group × Age 0 , P , .0001; Group × Time, P ¼ .018; Group × Age 0 × Time, P ¼ .015). Patients had poorer neuropsy- chological performance than controls as early as base- line, with significantly lower test scores on motor dexterity (Purdue Pegboard, P ¼ .008) and verbal learn- ing (Memory for Words, P ¼ .003) (Fig. 3 ). Performance improved with age in both groups on motor dexterity (Purdue Pegboard, Fig. 2 A), verbal learning (Memory for Words, Fig. 2 B), visuospatial working memory (Bead Memory, Fig. 2 C), and visual perception (visual perception test, Fig. 2 D) (all tests, P , .0001). However, different rates of change in test performance were found with age, such that neuropsychological def- icits relative to controls—in particular verbal learning, visuospatial working memory, and visual perception— were more pronounced in younger patients (Fig. 2 ). In Group Differences in Neuropsychological Performance

Results

Table 1 shows patient demographic information and treatment characteristics, and Table 2 shows control de- mographic information. The mean age at cranial irradi- ation was 11.8 years (range 1.1–18.6). The primary site was infratentorial in 5 / 19, supratentorial in 12 / 19, and leukemia in 2 / 19. Radiation treatment plans were cra- niospinal, n ¼ 8; whole brain radiation, n ¼ 3; and 3- dimensional or intensity-modulated RT, n ¼ 9. Mean prescription dose was 42.9 Gy (range 12 Gy–59.4 Gy). Eight patients (42%) received concurrent chemotherapy,

at Universitaet Leipzig, Institut fuer Informatik/URZ, Bibliothek on August 25, 2014 http://neuro-oncology.oxfordjournals.org/ Downloaded from

Table 1. Patient and treatment characteristics

n

%

Gender Male

12

63 37

Female

7

Age at diagnosis 0–4 y

4 3 8 4

21 16 42 21 68 21 11

5–9 y

10–14 y 15–19 y

Ethnicity

Caucasian

13

African American

4 2

Other

Handedness Right

18

95

Left

1

5

Diagnosis Glioma

4 5 3 2 2 1 1 1 8 3 8

21 26 16 11 11

Medulloblastoma / PNET

Germinoma

Leukemia

Nongerminoma germ cell tumor

Pineoblastoma

5 5 5

Table 2. Control characteristics

Craniopharyngioma

Ependymoma

n

%

RT technique

Gender Male

Craniospinal Whole brain

42 16 42 11 16 74

30 25

55 45

Female

3D conformal or IMRT

Age at enrollment 0–4 y

Radiation dose 0–20 Gy

0

0

2 3

5–9 y

19 21 15

35 38 27

21–49 Gy 50–60 Gy

10–14 y 15–19 y

14

Primary site

Ethnicity

Supratentorial Infratentorial

14

74 26

Caucasian

26 24

47 44

5

African American

Concurrent chemotherapy Yes

Other

5

9

8

42

Handedness Right

No 58 Abbreviations: PNET, primitive neuroectodermal tumor; IMRT, intensity-modulated RT. 11

44 11

80 20

Left

NEURO-ONCOLOGY † M A R C H 2 0 1 3

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