Intellectual, educational, and behavioural sequelae after cranial irradiation and chemotherapy.

Abstract

Cognitive and educational sequelae are inconsistently reported in children treated with cranial irradiation for acute lymphoblastic leukaemia. This study investigated differences in these skills after cranial irradiation, controlling the effects of chemotherapy and psychosocial factors. Three groups were evaluated: 100 children diagnosed with acute lymphoblastic leukaemia and treated with cranial irradiation and chemotherapy; 50 children diagnosed with acute lymphoblastic leukaemia or other cancers and treated with chemotherapy alone; and a healthy control group of 100 children. Children in the clinical groups stopped treatment at least two years before evaluation and had no history of relapse. Children were aged between 7 and 16 at the time of assessment. Evaluation included cognitive, educational, and behavioural measures.Analyses found that children receiving cranial irradiation and chemotherapy performed more poorly than non-irradiated groups on intellectual and educational tests, with verbal and attentional deficits most pronounced. Children receiving chemotherapy alone performed similarly to controls, suggesting such treatment is not associated with adverse neurobehavioural sequelae.

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.…”

Risk factors for intellectual and educational sequelae of cranial irradiation in childhood acute lymphoblastic leukaemia

“…Previous research has also suggested that educational difficulties may be a result of missed schooling (Eiser, 1980;Sawyer et al, 1989) but the observation that children in group 2, who also missed significant school time, are performing similarly to healthy controls argues against this explanation. Thus we have shown that the problem is related to treatment rather than psychosocial factors (Anderson et al, 1994). Dose of irradiation A number of previous studies have addressed the impact of high-or low-dose CRT, with little consensus with respect to findings (Trautman et al, 1988;Schuler et al, 1981;Appleton et al, 1990;Mulhern et al, 1992;Halberg et al, 1992;Hirsch et al, 1979).…”

“…There was no correlation between the presence of neurological signs and intellectual or educational deficits. The results have been published and discussed in detail (Anderson et al, 1994).…”

Late neurocognitive effects in children and adolescents who have undercone oncological treatment: a rehabilitation model

“…In addition, in survivors of medulloblastoma, a deficit in academic achievement, memory, attention, and processing speed has been evidenced [5, 9, 10, 13, 15-17, 19, 21] . Combined radio-and chemotherapy reduced cognitive performances and was associated with memory loss, concentration, and learning problems [5,[13][14][15][16]18] . The most commonly affected neurocognitive functions were loss of attention and concentration [9,10,19,21] , and memory problems [5,13,19] , in particular working memory [10,22] ; also the visuo-motor integration and visuo-spatial abilities [5,9,20,21,[23][24][25] , executive and verbal functions [13,14,20] , speed of execution [13,20] , and problem-solving abilities were affected [20] .…”