Neurocognitive outcomes after proton radiation for pediatric brain tumors.

Pulsifer, Margaret B.; Delgado, Irene López; Tarbell, Nancy J.; Kuhlthau, Karen; MacDonald, S.; Yock, T.I.

doi:10.1200/jco.2010.28.15_suppl.9508

Cited by 6 publications

(6 citation statements)

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“…Specifically, close proximity of these tumors to the brain, frequent intracranial extension, and the significant RT dose required for disease control all make adverse effects on neurocognition, hypothalamic/ pituitary function, and vision a risk. Proton radiation has demonstrated the ability to reduce dose to critical structures compared to intensity modulated radiation therapy (IMRT) in dosimetric studies of adult and pediatric head and neck malignancies through the elimination of exit dose and diminished entrance dose to normal tissues at depth [12,[23][24][25][26]. Further, clinical data from a mixed pediatric and adult population of over 1,000 patients has suggested a reduction in second tumor rates in a proton treated population compared to photons [21].…”

Section: Introductionmentioning

confidence: 99%

“…While radiation therapy (RT) can improve disease control in adult EN cohorts [2], the decision for its use in the pediatric population is complicated by a higher risk of late effects in the developing tissues of children [3,[11][12][13][14][15][16][17][18][19][20][21][22]. Specifically, close proximity of these tumors to the brain, frequent intracranial extension, and the significant RT dose required for disease control all make adverse effects on neurocognition, hypothalamic/ pituitary function, and vision a risk.…”

Section: Introductionmentioning

confidence: 99%

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Proton therapy for pediatric and adolescent esthesioneuroblastoma

Lucas

Ladra

MacDonald³

et al. 2015

Pediatric Blood & Cancer

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Proton therapy for pediatric and adolescent esthesioneuroblastoma

Lucas

Ladra

MacDonald³

et al. 2015

Pediatric Blood & Cancer

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“…One of these studies [28] suggested that young age at CRT is a further risk factor with Di Pinto et al [31] stating that young age at irradiation leads to smaller rates of increase in learning over time and Kieffer-Renaux et al [37] noting that IQ continues to decline more than four years post diagnosis. Conklin et al [32] identify that young age at CRT affects reading ability with Pulsifer et al [44] finding significant decline in processing speed and visual-spatial organisation in childhood ependymoma survivors. In contrast, six of the retrieved papers stated CRT does not predict poorer cognitive outcomes [7,23,29,30,36,41].…”

Section: Discussionmentioning

confidence: 99%

“…One child was irradiated (infratentorial) at <12 months. Of 14 papers reaching minimum quality standards, nine papers indicated radiotherapy for childhood ependymoma leads to lower IQ scores or poorer overall cognitive outcome [22,27,28,31,33,35,37,42,44] compared to norms. One of these studies [28] suggested that young age at CRT is a further risk factor with Di Pinto et al [31] stating that young age at irradiation leads to smaller rates of increase in learning over time and Kieffer-Renaux et al [37] noting that IQ continues to decline more than four years post diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Recommendations for Assessing Cognitive Risks in Young Children Treated for Ependymoma for Clinical and Research Protocols: Evidence from a Systematic Literature Review

Morrall¹

2014

J. Pediatr. Oncol.

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. (2014) Recommendations for assessing cognitive risks in young children treated for ependymoma for clinical and research protocols: evidence from a systematic literature review. Journal of Pediatric Oncology, 2 (1). pp. 24-39. ISSN 2309-3021 Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/34633/1/JPOV2N1A4-Morrall.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the Creative Commons Attribution Non-commercial licence and may be reused according to the conditions of the licence. For more details see: http://creativecommons.org/licenses/by-nc/2.5/ A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription.For more information, please contact eprints@nottingham.ac.uk European approaches use chemotherapy to avoid or defer radiotherapy until three years of age, in order to avoid late neurocognitive toxicity. To establish evidence for the effects of cranial radiotherapy in children aged <36 months with ependymoma on neurocognitive outcomes, we conducted a systematic literature review assessing methodological approaches for measuring neurocognitive outcome. Methods: Eight databases were selected to perform an advanced search, retrieval and systematic review of papers describing neurocognitive outcome in children diagnosed with ependymoma who received cranial radiotherapy at <36 months. Results: Limitations of published data permitted descriptive analysis only. Considerable variation in reporting survival rates, techniques and timing of psychometric testing and the results of neurocognitive outcomes was identified. Conclusions: The review identified significant inconsistencies of neurocognitive testing, particularly literacy skills, developmental time points for testing and methods of data reporting. The role of the cerebellum for cognitive development, especially reading, has been inadequately evaluated in published studies. Recommendations are made to improve assessment methods, and time points for testing, so that reports do not fail to identify children who acquire deficits as they mature through childhood and adolescence. We conclude that claims that radiation treatment for ependymoma administered aged <36 months is associated with limited neurocognitive consequences, are not supported by the literature.

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“…Recently, early clinical outcomes for 45 standard risk and 14 highrisk medulloblastoma patients treated with protons from 2003 to 2009 were reported by Pulsifer et al [31]. After maximal safe resection, all patients received CSI with protons radiotherapy to doses ranging from 18 to 36 Gy (RBE), plus additional dose to the tumor bed or posterior fossa for a total prescribed dose of 54 -55.8Gy (RBE).…”

Section: Medulloblastomamentioning

confidence: 99%

Proton Radiotherapy for Childhood Tumors: an Overview of Early Clinical Results

MacDonald¹

2013

J Nucl Med Radiat Ther

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Radiation therapy (RT) is an important part of a multidisciplinary treatment for many pediatric tumors and has been integral to the improvement in disease control seen over the past few decades. However, long-term survivors experience late morbidity related to RT. Proton radiation therapy is an emerging type of radiotherapy that can mitigate the incidence of acute and late side effects by minimizing the dose of radiation to normal tissues with a significant reduction of integral dose compared with photons. Furthermore, true clinical advantages are now being measured and published in the medical literature, showing both excellent disease control rates and reduction of late effects. The purpose of this review is to summarize the early clinical outcomes after proton radiotherapy in childhood available in the literature.

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Neurocognitive outcomes after proton radiation for pediatric brain tumors.

Cited by 6 publications

References 0 publications

Proton therapy for pediatric and adolescent esthesioneuroblastoma

Proton therapy for pediatric and adolescent esthesioneuroblastoma

Recommendations for Assessing Cognitive Risks in Young Children Treated for Ependymoma for Clinical and Research Protocols: Evidence from a Systematic Literature Review

Proton Radiotherapy for Childhood Tumors: an Overview of Early Clinical Results

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