Estimated IQ Systematically Underestimates Neurocognitive Sequelae in Irradiated Pediatric Brain Tumor Survivors

Burgess, Laura; Pulsifer, Margaret B.; Grieco, Julie A.; Weinstein, Elliott R.; Gallotto, Sara L.; Weyman, Elizabeth A.; MacDonald, Shannon M.; Tarbell, Nancy J.; Yeap, Beow Y.; Yock, Torunn I.

doi:10.1016/j.ijrobp.2018.03.012

Cited by 17 publications

(16 citation statements)

References 39 publications

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“…Indeed, there is some suggestion that estimated IQ scores may not accurately reflect neurocognitive weaknesses in patients with brain tumors who have undergone radiation. 46 Further, prior studies that have found associations between cognitive and social functioning have assessed one of these indices. 11,12,47 This study was launched prior to this establishment, and thus, these indices were not routinely assessed in all patients (eg, only available for those school-aged and older).…”

Section: Discussionmentioning

confidence: 99%

Trajectories of psychosocial and cognitive functioning in pediatric patients with brain tumors treated with radiation therapy

et al. 2019

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Background. Pediatric patients with brain tumors who are treated with radiation therapy (RT) are at risk for neurocognitive and psychosocial late effects. Research to date has primarily examined these outcomes at a group level and in isolation. Advanced statistical techniques allow for person-centered analyses, as well as examination of relationships between domain-specific trajectories. Methods. Patients with brain tumors (craniopharyngioma, ependymoma, low-grade astrocytoma, high-grade astrocytoma) were enrolled on a phase II clinical trial of RT. Three hundred and fifty patients completed serial neurocognitive assessments as part of their treatment monitoring, including pre-RT baseline, 6 months post-RT, and then yearly for 5 years. This secondary analysis focused on outcomes of cognition (estimated IQ, parent-reported attention problems) and psychosocial effects (parent-reported socialization and social problems) post-RT. Results. Latent growth curve modeling indicated that estimated IQ and socialization were best served by quadratic models, while attention and social problems were best served by linear models. Growth mixture modeling indicated 3-class models were the best fit for IQ and socialization, and 2-class models for attention and social problems. Baseline IQ and socialization scores were associated, but there was no association over time. Young age at diagnosis and pre-RT treatments (surgery, chemotherapy) were associated with class membership. Conclusions. Person-centered statistical analyses provide rich information regarding the variability in neurocognitive and psychosocial functioning following RT for pediatric brain tumor. While many patients do well over time, a subset are exhibiting significant cognitive and/or psychosocial deficits. Class membership was associated with some medical factors (eg, pre-radiation surgery/chemotherapy, age at diagnosis, shunted hydrocephalus). Key Points • Pediatric patients with brain tumors are at risk for cognitive and psychosocial late effects. • Person-centered analytical techniques support understanding of the variability in functioning. • While many patients do well, a subset are exhibiting weaknesses.

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Section: Discussionmentioning

confidence: 99%

Trajectories of psychosocial and cognitive functioning in pediatric patients with brain tumors treated with radiation therapy

et al. 2019

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“…23,24 The negative effect of a shunt is also maintained in studies that included brain tumors beyond these 2 histologies. 41,42 However, it should be noted that a shunt is often unavoidable in these patients. It is likely that VP shunt is an indicator of severe hydrocephalus requiring surgical treatment.…”

Section: Tsang Et Al Intellectual Function After Rtmentioning

confidence: 99%

Intellectual changes after radiation for children with brain tumors: which brain structures are most important?

et al. 2020

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Background The objective of this study was to evaluate the contribution of radiation dose to different intracranial structures on changes in intellectual function for children with brain tumors. Methods We evaluated children with brain tumors treated from 2005-2017 who had longitudinal neuropsychological assessments and available photon dosimetric data (if RT given). Full scale intelligence quotient (FSIQ) and index scores were evaluated (perceptual reasoning [PRI], processing speed [PSI], verbal comprehension [VCI] and working memory [WMI]). Multivariable linear mixed effects models were used to model endpoints, with age at RT and dose to different brain regions as fixed effects and patient-specific random intercepts. P-values (p*) were adjusted for multiple comparisons. Results Sixty-nine patients were included, 56 of whom received RT. Median neuropsychological follow-up was 3.2 years. Right temporal lobe mean dose was strongly associated with decline in FSIQ (p* = 0.005); with each gray increase in mean dose, there was a decrease of 0.052 FSIQ points per year. Dose to 50% (D50) of the supratentorial brain was associated with decline in PSI (p* = 0.006) and WMI (p* = 0.001). Right and left hippocampus D50 were individually strongly associated with declines in VCI (p* = 0.009 for each). Presence of ventriculoperitoneal shunt decreased FSIQ by 10 points. Conclusions We reported associations between dosimetry to specific brain regions and intellectual outcomes, with suggested avoidance structures during RT planning. These models can help clinicians anticipate changes in neurocognition post-RT and guide selection of an optimal RT plan.

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“…Findings from exploratory analyses were striking in that the majority of patients demonstrated significant variability between domains of cognitive functioning—verbal, nonverbal, spatial—that were large enough to invalidate the use of an overall cognitive composite/indicator of IQ. While the use of IQ composites has been previously questioned due to the high rates of deficits in working memory and processing speed in the pediatric brain tumor population [21,22], this analysis highlights the variability in broader cognitive abilities as well. This finding is consistent with our clinical observations over 20 years of administering assessments that variability across domains of cognitive functioning is relatively common, but the research literature is mixed on this finding.…”

Section: Discussionmentioning

confidence: 99%

Cognitive and Psychosocial Development in Young Children with Brain Tumors: Observations from a Clinical Sample

et al. 2019

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Survivors of pediatric brain tumor (BT) are known to be at risk for developing cognitive and psychosocial late effects. Young age at treatment (≤6 years) is typically considered to put patients at increased risk. However, there is limited research specifically exploring functioning in these young patients. Cognitive and psychosocial data were retrospectively abstracted from medical charts for 79 young patients (54.4% male) treated for BT with a variety of treatment modalities (e.g., surgery, radiation therapy, chemotherapy). Children were clinically assessed at 4.52 years of age (range = 1.48–5.98) and most were off-therapy (74.4%). Mean performances on developmental (68.3 ± 10.02), cognitive (88.09 ± 18.38), and pre-academic (86.84 ± 19.75) measures were all below average. Parent report of adaptive functioning was also below average (82.10 ± 16.21), but psychosocial functioning was generally within normal limits. Most patients had impaired functioning (scores <10th percentile) in at least one domain assessed. Exploratory analyses revealed that many patients (27.3–60.6%) exhibited a significant discrepancy between domains of cognitive functioning (e.g., verbal and spatial). Young children treated for BT experienced high rates of impairment in cognitive, pre-academic, and adaptive domains. Future work is needed to focus on serial longitudinal assessment of these young patients, as well as dedicated intervention and prevention efforts.

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Estimated IQ Systematically Underestimates Neurocognitive Sequelae in Irradiated Pediatric Brain Tumor Survivors

Cited by 17 publications

References 39 publications

Trajectories of psychosocial and cognitive functioning in pediatric patients with brain tumors treated with radiation therapy

Trajectories of psychosocial and cognitive functioning in pediatric patients with brain tumors treated with radiation therapy

Intellectual changes after radiation for children with brain tumors: which brain structures are most important?

Cognitive and Psychosocial Development in Young Children with Brain Tumors: Observations from a Clinical Sample

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