Intellectual performance after presymptomatic cranial radiotherapy for leukaemia: effects of age and sex.

Abstract

Cognitive outcome, as measured by verbal and performance IQs, was compared in 35 girls and 47 boys who were in first remission for acute lymphoblastic leukaemia. All children had received presymptomatic cranial radiotherapy and intrathecal methotrexate. The mean age at diagnosis was 4*2 years and the mean elapsed time from initial diagnosis to intellectual assessment was 7-1 years.Results showed that children irradiated before the age of 4 years were impaired in certain aspects of non-verbal ability, as well as in measures of short term memory and attention, calculated by factor scores derived from selected subtests of the IQ test. Subtests requiring verbal and nonverbal reasoning showed the greatest impairment after early diagnosis and treatment. In addition girls were selectively impaired in verbal IQ and other aspects ofverbal ability, with the degree of impairment exacerbated by early treatment. No relationship was found between degree ofimpairment and either time since treatment or number of methotrexate injections. It is concluded that early age at irradiation increases the risk of impaired intellectual outcome, particularly in girls.

Lithium Treatment Prevents Neurocognitive Deficit Resulting from Cranial Irradiation

“…This alteration could be due to hippocampus-specific apoptosis because in our study even small doses of radiation (1-2 Gy) induced apoptosis in the subgranular zone of the developing hippocampus but not in other areas of the brain. Female mice were more affected than males, which is also seen in clinical studies of females suffering more severe radiation-induced cognitive decline compared with males (4,5,33,38). Treatment with LiCl before cranial irradiation improved performance in the Morris water maze, suggesting that lithium attenuates the cognitive deficits that result from cranial irradiation.…”

Twenty-five–year follow-up among survivors of childhood acute lymphoblastic leukemia: a report from the Childhood Cancer Survivor Study

“…19,26,27,[54][55][56] Female survivors, those who received cranial radiation, and brain tumor survivors have been shown to be at greatest risk for these types of outcomes. 27,[60][61][62] Among our adult ALL survivors, both males and females uniformly reported worse socioeconomic outcomes than did siblings in all areas. Irradiated survivors, especially females, reported poorer socioeconomic outcomes.…”

Lack of benefit of spinal irradiation in the primary treatment of intracranial germinoma

“…3,[5][6][7][8] Cranial irradiation leads to late adverse effects, including intellectual deficits, hormonal abnormalities, arterial obstruction, and secondary malignancies. 5,11,19,[27][28][29][30] Diabetes insipidus, panhypopituitarism, and delayed gonadal function are observed frequently in patients with intracranial germinoma at initial evaluation. 4,7,8,25,28 Few authors have evaluated the frequency of radiation-induced adverse effects correctly by comparing intellectual status and hormonal abnormalities before and after treatment.…”