Assessment of the long-term effects of primary radiation. Therapy for brain tumors in children

Abstract

One-hundred-twelve children with primary brain tumors received definitive radiotherapy between the years 1958--1979. Sixty-nine patients were alive at intervals of 1--21 years. Thirty-eight patients underwent neurologic and endocrine evaluation, psychologic and intelligence testing, and assessement for second malignancy post-treatment. A second intracranial malignancy developed in one child, for an incidence of 1.6%. Performance status was good to excellent in 89% of the patients studied. Seventeen percent of the group were mentally retarded. Behavioral disorders were identified in 39% of the patients, 59% of the mothers, and 43% of the fathers. Of the 23 patients with nonparasellar tumors, six were found to have growth hormone deficiency, including two patients with panhypopituitarism. Disability was related to age under 3 years at the time of treatment and tumor extension to the hypothalamus.

Neuropsychological evaluation of children with intracranial tumors: Impact of treatment modalities

“…Perhaps dosages similar to those used in meningeal prophylaxis in children with leukemia would be sufficient to sterilize any possible micrometastases of the ICT. It is controversial whether or not such a reduction would be preferable also from the point of view that these lower dosages produce a less significant deterioration in neuropsychological functions [39,40]. Tomita and Mclone [41], Brand et al [42], and Halberg et al [43] have shown that the prophylactic radiation dose to the cranial-spinal axis can be decreased without jeopardizing control rate and survival in patients, mainly in those low risk patients who have had a total surgical tumor resection and negative myelography and cerebrospinal fluid cytology.…”

Cognitive Dysfunction and Histological Findings in Adult Rats One Year After Whole Brain Irradiation.

“…19) Whole brain radiation (WBR) is recommended for patients with high-grade malignant gliomas or central nervous system (CNS) lymphomas, and for those undergoing craniospinal irradiation for medulloblastoma or CNS prophylaxis for leukemia. 10,19,28,32) However, cognitive impairment or mental retardation in children 5,6,28) and psychomotor disturbance or severe dementia in the elderly 3,10,16,20) are frequently reported. Such adverse reactions to WBR have been attributed to radiation encephalopathy 1,8) or (delayed) radiation necrosis.…”

“…31) However, the long-term intellectual impairment and neurophysiological deficits related to radiotherapy arising as a result of damage to myelin are not similar to the deficits due to delayed radiation necrosis resulting from damage of the vascular walls. 1,6,21,31,33,34,36) Nevertheless, the mechanism of radiation encephalopathy or radiation necrosis after WBR has not yet been clarified. Progressive psychomotor disturbance or severe dementia and brain atrophy may occur after irradiation.…”

Behavioral consequences of radiation exposure to simulated space radiation in the C57BL/6 mouse: Open field, rotorod, and acoustic startle

“…Similarly, mean doses of 1.3 Gy have been shown to produce long-term impairment of the mental function of children who received X-ray treatment for tinea capitis, a fungal scalp infection. When evaluated almost 20 years later, these patients scored lower on scholastic aptitude, WISC, and other psychological tests and had an increased risk for mental hospital admissions (Danoff, Cowchock, Marquette, Mulgrew, & Kramer, 1982;Ron, Modan, Floro, Harkedar, & Gurewitz, 1982;Shore, Albert, & Pasternack, 1976).…”