Cognitive predictors of social adjustment in pediatric brain tumor survivors treated with photon versus proton radiation therapy

Abstract

Background Pediatric brain tumor survivors are at risk for poor social outcomes. It remains unknown whether cognitive sparing with proton radiotherapy (PRT) supports better social outcomes relative to photon radiotherapy (XRT). We hypothesized that survivors treated with PRT would outperform those treated with XRT on measures of cognitive and social outcomes. Further, we hypothesized that cognitive performance would predict survivor social outcomes. Procedure Survivors who underwent PRT (n = 38) or XRT (n = 20) participated in a neurocognitive evaluation >1 year post radiotherapy. Group differences in cognitive and social functioning were assessed using analysis of covariance (ANCOVA). Regression analyses examined predictors of peer relations and social skills. Results Age at evaluation, radiation dose, tumor diameter, and sex did not differ between groups (all p > .05). XRT participants were younger at diagnosis (XRT M = 5.0 years, PRT M = 7.6 years) and further out from radiotherapy (XRT M = 8.7 years, PRT M = 4.6 years). The XRT group performed worse than the PRT group on measures of processing speed (p = .01) and verbal memory (p < .01); however, social outcomes did not differ by radiation type. The proportion of survivors with impairment in peer relations and social skills exceeded expectation; χ2(1) = 38.67, p < .001; χ2(1) = 5.63, p < .05. Household poverty predicted peer relation difficulties (t = 2.18, p < .05), and verbal memory approached significance (t = −1.99, p = .05). Tumor diameter predicted social skills (t = −2.07, p < .05). Conclusions Regardless of radiation modality, survivors are at risk for social challenges. Deficits in verbal memory may place survivors at particular risk. Results support monitoring of cognitive and social functioning throughout survivorship, as well as consideration of sociodemographic risk factors.

Influences on cognitive outcomes in adult patients with gliomas: A systematic review

“…For example, proton radiotherapy may be associated with superior cognitive outcomes compared to photon radiotherapy, due to reduced radiation delivery to uninvolved neural tissue associated with the former treatment. Indeed, evidence from children with brain tumors supports this assertion ( 176 – 179 ). However, there are no robust comparative data confirming this in adult glioma patients, requiring further study.…”

Superior verbal learning and memory in pediatric brain tumor survivors treated with proton versus photon radiotherapy.

“…Direct comparisons between different types of radiotherapy may help to elucidate these questions. Warren et al (2022) reported significantly poorer verbal memory (i.e., delayed recall) but not verbal learning (i.e., total recall on learning trials) on the CVLT for survivors treated with XRT compared to PRT. Moreover, poor delayed recall predicted worse peer relations in this sample.…”

“…With many patients now surviving into adulthood, research has increasingly focused on long-term outcomes in this population (Ris, 2007). Adult survivors of pediatric brain tumor tend to have lower social attainment, academic achievement, and functional independence compared to same-age peers (King et al, 2017; Schulte et al, 2019; Warren et al, 2022). These negative outcomes may reflect treatment-related declines in cognitive functioning (Roth et al, 2020).…”

“…Accumulating evidence suggests that neurocognitive outcomes may be improved in patients treated with PRT versus XRT. Compared to patients receiving PRT, those treated with XRT are more likely to experience global intellectual impairment, as well as deficits in attention, executive functioning, and fine motor control (Baliga & Yock, 2019; Child et al, 2021; Gross et al, 2019; Warren et al, 2022). CSI has consistently emerged as a major risk factor for cognitive impairment, especially when delivered with XRT.…”

Cognitive Sparing in Proton versus Photon Radiotherapy for Pediatric Brain Tumor Is Associated with White Matter Integrity: An Exploratory Study

“…Central nervous system (CNS)-directed radiotherapy is often a life-saving treatment, but it has been associated with significant long-term morbidity, including progressive cognitive decline [ 2 , 3 , 4 ]. As survivorship has improved over recent decades [ 5 ], accumulating evidence suggests that cognitive changes may, in turn, impact later psychosocial outcomes in adulthood, such as employment, social attainment, and independent living skills [ 6 , 7 , 8 , 9 ]. Elucidating the underlying mechanisms of neurocognitive decline may aid in the selection of treatments that minimize cognitive sequelae and improve functional outcomes.…”