Cognitive and academic outcome following cranial irradiation and chemotherapy in children: a longitudinal study

Abstract

Cranial irradiation therapy (CRT) and chemotherapy are associated with neurobehavioural deficits. Many studies have investigated late effects of these treatments, but few have evaluated changes in abilities over time. This study employed a longitudinal design to map abilities following these treatments. Three groups of children were studied: Group 1 (n = 35): children treated with CRT (18 Gy) + chemotherapy, aged 5 years or less at time of diagnosis; Group 2 (n = 19): children treated with chemotherapy alone, aged 5 years or less at time of diagnosis; Group 3 (n = 35): healthy children. All children were aged 7–13 years at time of initial assessment, with no pre-diagnosis history of neurologic, developmental, or psychiatric disorder. Intellectual and educational abilities were evaluated twice: T1, not less than 2 years post-treatment, and T2, 3 years later. Group 1 achieved poorest results at T1, with comparison groups performing similarly. At T2 group differences were maintained. For verbal skills differences remained stable. Group 1 exhibited deterioration on non-verbal and processing tasks, while comparison groups showed improved abilities. Group 1 exhibited increases in literacy skills, with educational intervention predicting progress. Results suggest cumulative deficits in non-verbal and information processing skills for children treated with CRT + chemotherapy, with other deficits remaining relatively stable over time. Improved literacy skills suggest that gains can occur with remediation. © 2000 Cancer Research Campaign

Educational outcomes among survivors of childhood cancer in British Columbia, Canada

“…CRT is associated with poor educational outcomes among survivors of childhood cancer, 24,27,28 as we also demonstrated in the current study. Reports have indicated that IT MTX is a risk factor for poor cognitive performance and neurologic function.…”

“…Younger age at diagnosis and/or treatment 7,14,[24][25][26] ; cranial or craniospinal radiotherapy (CRT) and/or intrathecal methotrexate (IT MTX) 15,24,25,[27][28][29] ; higher therapeutic doses of CRT or IT MTX 17,24 ; and diagnoses of central nervous system (CNS) tumors, leukemia (particularly acute lymphoblastic leukemia [ALL]), Hodgkin lymphoma, or neuroblastoma 13,15,30 as well as being female, [30][31][32][33] of lower socioeconomic status (SES), 20 and having a longer time since diagnosis 24 have been reported to be associated with an increased risk of poorer educational outcomes. Previous studies have not always assessed the potential confounding effects of missed school, 34 SES, 35 and physical health or physical impairments.…”

Visuomotor control in survivors of childhood acute lymphoblastic leukemia treated with chemotherapy only

“…This has resulted in an increasing interest in the late effects of disease and treatment on physical, mental and social well-being of the survivors. Several elements of therapy for ALL may affect the function of the central and peripheral nervous system, and cognitive deficits (e.g., Anderson et al, 2000;Brown et al, 1992;Butler et al, 1994;Moleski, 2000;Ochs et al, 1991) as well as gross and fine motor impairments (Galea et al, 2004;HarilaSaari et al, 2001;Lehtinen et al, 2002;Reinders-Messelink et al, 1996;Vainionpaa, 1993;Wright et al, 1998) have been reported in survivors of childhood ALL. CNS-directed treatment is a standard component of therapy for ALL.…”

Pathogenesis of Cognitive Decline Following Therapeutic Irradiation for Head and Neck Tumors

“…The problem of cognitive decline associated with irradiation for brain tumors and prophylaxis for leukemia has received much attention in children but less so in adults (1)(2)(3). N evertheless, the problem of cognitive impairment associated with cranial irradiation is well recognized in adults (4 -6).…”