scholarly journals Improved neuropsychological outcomes following proton therapy relative to X-ray therapy for pediatric brain tumor patients

2019 ◽  
Vol 21 (7) ◽  
pp. 934-943 ◽  
Author(s):  
Jeffrey P Gross ◽  
Stephanie Powell ◽  
Frank Zelko ◽  
William Hartsell ◽  
Stewart Goldman ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Processing Speed ◽  
Adaptive Functioning ◽  
Pediatric Brain Tumor ◽  
Neuropsychological Evaluation ◽  
Tumor Patients ◽  
X Ray ◽  
Neuropsychological Outcomes ◽  
Pediatric Brain

AbstractBackgroundSurvivors of pediatric brain tumors are at risk for impaired development in multiple neuropsychological domains. The purpose of this study was to compare neuropsychological outcomes of pediatric brain tumor patients who underwent X-ray radiotherapy (XRT) versus proton radiotherapy (PRT).MethodsPediatric patients who underwent either XRT or PRT and received posttreatment age-appropriate neuropsychological evaluation—including measures of intelligence (IQ), attention, memory, visuographic skills, academic skills, and parent-reported adaptive functioning—were identified. Multivariate analyses were performed to assess differences in neuropsychological outcomes and included tests for interaction between treatment cohort and follow-up time.ResultsBetween 1998 and 2017, 125 patients with tumors located in the supratentorial (17.6%), midline (28.8%), or posterior fossa (53.6%) compartments received radiation and had posttreatment neuropsychological evaluation. Median age at treatment was 7.4 years. The PRT patient cohort had higher estimated SES and shorter median time from radiotherapy completion to last neuropsychological evaluation (6.7 vs 2.6 y, P < 0.001). On multivariable analysis, PRT was associated with higher full-scale IQ (β = 10.6, P = 0.048) and processing speed (β = 14.4, P = 0.007) relative to XRT, with trend toward higher verbal IQ (β = 9.9, P = 0.06) and general adaptive functioning (β = 11.4, P = 0.07). Planned sensitivity analyses truncating follow-up interval in the XRT cohort re-demonstrated higher verbal IQ (P = 0.01) and IQ (P = 0.04) following PRT, with trend toward improved processing speed (P = 0.09).ConclusionsPRT is associated with favorable outcomes for intelligence and processing speed. Combined with other strategies for treatment de-intensification, PRT may further reduce neuropsychological morbidity of brain tumor treatment.

Benefit of Static FET PET in Pretreated Pediatric Brain Tumor Patients with Equivocal Conventional MRI Results

2021 ◽  
Author(s):  
Frederik Grosse ◽  
Florian Wedel ◽  
Ulrich-Wilhelm Thomale ◽  
Ingo Steffen ◽  
Arend Koch ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Tumor Tissue ◽  
Pediatric Brain Tumor ◽  
Ct Scans ◽  
Tumor Patients ◽  
Fet Pet ◽  
Conventional Mri ◽  
Pet Ct ◽  
Pediatric Brain

Abstract Background MRI has shortcomings in differentiation between tumor tissue and post-therapeutic changes in pretreated brain tumor patients. Patients We assessed 22 static FET-PET/CT-scans of 17 pediatric patients (median age 12 years, range 2–16 years, ependymoma n=4, medulloblastoma n=4, low-grade glioma n=6, high-grade glioma n=3, germ cell tumor n=1, choroid plexus tumor n=1, median follow-up: 112 months) with multimodal treatment. Method FET-PET/CT-scans were analyzed visually by 3 independent nuclear medicine physicians. Additionally quantitative FET-Uptake for each lesion was determined by calculating standardized uptake values (SUVmaxT/SUVmeanB, SUVmeanT/SUVmeanB). Histology or clinical follow-up served as reference. Results Static FET-PET/CT reliably distinguished between tumor tissue and post-therapeutic changes in 16 out of 17 patients. It identified correctly vital tumor tissue in 13 patients and post-therapeutic changes in 3 patients. SUV-based analyses were less sensitive than visual analyses. Except from a choroid plexus carcinoma, all tumor entities showed increased FET-uptake. Discussion Our study comprises a limited number of patients but results corroborate the ability of FET to detect different brain tumor entities in pediatric patients and discriminate between residual/recurrent tumor and post-therapeutic changes. Conclusions We observed a clear benefit from additional static FET-PET/CT-scans when conventional MRI identified equivocal lesions in pretreated pediatric brain tumor patients. These results warrant prospective studies that should include dynamic scans.

scholarly journals RONC-22. IMPACT OF RADIOTHERAPY MODALITY ON NEUROPSYCHOLOGICAL OUTCOMES OF PEDIATRIC BRAIN TUMOR PATIENTS

2018 ◽  
Vol 20 (suppl_2) ◽  
pp. i179-i179
Author(s):  
Jeffrey Gross ◽  
Stephanie Powell ◽  
Frank Zelko ◽  
William Hartsell ◽  
Stewart Goldman ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Pediatric Brain Tumor ◽  
Tumor Patients ◽  
Neuropsychological Outcomes ◽  
Pediatric Brain

Predictors of cognitive function in pediatric brain tumor patients: pre-surgery through 24-month follow-up

2019 ◽  
pp. 1-8
Author(s):  
Claire E. Fraley ◽  
Jennifer C. Thigpen ◽  
Matthew M. Pearson ◽  
John F. Kuttesch ◽  
Leandra Desjardins ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Cognitive Function ◽  
Pediatric Brain Tumor ◽  
Tumor Patients ◽  
Pediatric Brain

Biologic Dose and Imaging Changes in Pediatric Brain Tumor Patients Receiving Spot Scanning Proton Therapy

2019 ◽  
Vol 105 (3) ◽  
pp. 664-673 ◽  
Author(s):  
Kristofer W. Roberts ◽  
Hok Seum Wan Chan Tseung ◽  
Laurence J. Eckel ◽  
William S. Harmsen ◽  
Chris Beltran ◽  
...  
Keyword(s):  
Brain Tumor ◽  
Proton Therapy ◽  
Pediatric Brain Tumor ◽  
Tumor Patients ◽  
Spot Scanning ◽  
Pediatric Brain

IQ change within three years of radiation therapy in pediatric brain tumor patients treated with proton beam radiation therapy versus photon radiation therapy.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 10009-10009
Author(s):  
Lisa Kahalley ◽  
M. Fatih Okcu ◽  
M. Douglas Ris ◽  
David Grosshans ◽  
Arnold Paulino ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pediatric Brain Tumor ◽  
Pediatric Brain Tumors ◽  
Tumor Patients ◽  
Beam Radiation ◽  
Proton Beam Radiation ◽  
Iq Scores ◽  
Pediatric Brain ◽  
Proton Beam Radiation Therapy

10009 Background: Radiation therapy (RT), an essential treatment for pediatric brain tumors, increases the risk of cognitive impairment. Advanced RT techniques reduce the volume of normal tissues receiving radiation dose. Proton beam radiation therapy (PBRT) minimizes irradiation to surrounding healthy brain tissue, with the potential to preserve cognitive function better than photon radiotherapy (XRT). We examined change in IQ over time between patients treated for pediatric brain tumors with PBRT versus XRT. Methods: IQ scores obtained in the first 3 years post-RT were abstracted for pediatric brain tumor patients treated with PBRT or XRT. Results: Baseline and follow-up IQ scores were available for 53 survivors (31 PBRT, 22 CRT). A linear regression model predicted follow-up IQ scores controlling for baseline IQ, age-at-RT, time-since-RT, and craniospinal irradiation (CSI), F(7,45)=23.4, p<.001. Follow-up IQ scores were significantly lower in the XRT group compared to the PBRT group (p<.05). The XRT group lost 10.3 IQ points on average with each additional year post-RT (p<.01), while the PBRT group remained stable, losing only 0.1 points per year on average (p<.05). CSI was associated with IQ decline in both groups (p<.05), while age-at-RT was not in either group (p=.154). Total RT dose was not associated with IQ with the above variables in the model. Conclusions: Findings suggest significant cognitive risk is associated with XRT, with IQ scores declining by more than half a standard deviation with each additional year post-RT. In contrast, IQ remained stable in the PBRT group. Preliminary findings suggest that PBRT may spare cognitive functioning in the first 3 years post-RT. Future research should replicate these findings with a larger sample and should study longer-term cognitive outcomes in patients treated with PBRT versus XRT. [Table: see text]

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