Intellectual Outcome After Reduced-Dose Radiation Therapy Plus Adjuvant Chemotherapy for Medulloblastoma: A Children’s Cancer Group Study

• Published in: Journal of clinical oncology Vol. 19; no. 15; pp. 3470 - 3476
• Main Authors: Ris, M. Douglas, Packer, Roger, Goldwein, Joel, Jones-Wallace, Dana, Boyett, James M.
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.08.2001; Lippincott Williams & Wilkins
• Subjects: Adolescent; Antineoplastic agents; Biological and medical sciences; Brain Neoplasms - drug therapy; Brain Neoplasms - radiotherapy; Brain Neoplasms - therapy; Chemotherapy, Adjuvant - adverse effects; Child; Child, Preschool; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Cranial Irradiation - adverse effects; Dose-Response Relationship, Radiation; Female; Humans; Intelligence - drug effects; Intelligence - radiation effects; Intelligence Tests; Longitudinal Studies; Male; Medical sciences; Medulloblastoma - drug therapy; Medulloblastoma - radiotherapy; Medulloblastoma - therapy; Neuroectodermal Tumors, Primitive - drug therapy; Neuroectodermal Tumors, Primitive - radiotherapy; Neuroectodermal Tumors, Primitive - therapy; Pharmacology. Drug treatments; Radiotherapy - adverse effects; Nervous system diseases; Drug combination; Nitrosoureas; Adjuvant treatment; Malignant tumor; Radiotherapy; Vincristine; Cisplatin; Neuroectodermal tumor; Malignant glioma; Alkylating agent; Alkaloid; Chemotherapy; Radiation dose; Reduction; Medulloblastoma; Central nervous system disease; Lomustine; Combined treatment; Antimitotic; Platinum II Complexes; Intelligence quotient
• ISSN: 0732-183X; 1527-7755
• DOI: 10.1200/jco.2001.19.15.3470

PURPOSE: To investigate the intellectual outcomes of children with medulloblastomas/primitive neuroectodermal tumors (MB/PNET) treated with reduced-dose craniospinal radiotherapy (RT) plus adjuvant chemotherapy. PATIENTS AND METHODS: Forty-three children with average-risk posterior fossa MB/PNETs underwent longitudinal intelligence testing. All had been treated with a reduced-dose craniospinal RT regimen (23.4 Gy to the neuraxis, 32.4-Gy boost to the posterior fossa) and adjuvant chemotherapy. RESULTS: The estimated rate of change from baseline was significant for Full Scale Intelligence Quotient (FSIQ), Verbal IQ (VIQ), and Nonverbal IQ (NVIQ) (P < .001 for all three outcomes). The rate of change was estimated to be −4.3 FSIQ points per year, −4.2 VIQ points per year, and −4.0 NVIQ points per year. Females were more subject to VIQ decline than were males (P = .008), and young children (< 7 years of age) were more negatively affected than were older children, with a significant decline in NVIQ (P = .016). Finally, patients with higher baseline evaluations suffered greater declines in IQ than did those with lower baseline scores. CONCLUSION: This study represents the largest series of patients with average-risk MB/PNETs treated with a combination of reduced-dose RT and adjuvant chemotherapy whose intellectual development has been followed prospectively. Intellectual loss was substantial but suggestive of some degree of intellectual preservation compared with effects associated with conventional RT doses. However, this conclusion remains provisional, pending further research.