Neuropsychological Status in Children and Young Adults with Benign and Low-Grade Brain Tumors Treated Prospectively with Focal Stereotactic Conformal Radiotherapy

Abstract

Purpose/Objective: To present prospective neuropsychological data at baseline and follow up in children and young adults with benign and low-grade gliomas treated with focal stereotactic conformal radiotherapy (SCRT). Materials/Methods: Twenty-two patients (age: 4 to 25 years) with residual/progressive benign and low-grade brain tumors considered suitable for SCRT underwent a detailed and in-depth neuropsychological and cognitive testing at baseline before radiotherapy. The test battery included measurement of age-adjusted intelligence quotients (IQ), cognitive parameters of visual, spatial, visuomotor and attention concentrations. Anxiety was measured by State-Trait Anxiety Inventory for Children (STAIC) and Hamilton Anxiety rating Scale (HARS) for patients more than 16 years of age. Patients were treated with high precision conformal radiotherapy under stereotactic guidance to a dose of 54Gy in 30 fractions. All neuropsychological assessments were repeated at 6 and 24 month after the completion of SCRT and compared with the baseline values. Results: The baseline mean full scale IQ before starting RT for patients less than 16 years was 82 (range 33–105) and for those older than 16 years, the corresponding value was 72 (range 64–129). 14 out of 20 evaluable patients (70%) had less than average IQ′s at baseline, even before starting radiotherapy. Verbal IQ, performance IQ and full scale IQ′s as well as other cognitive scores did not change significantly at 6 and 24 months follow up assessments for all patients. Memory quotient in older children and young adults remained maintained at 6 months and 2 years after SCRT with mean values of 93 and 100 compared to mean baseline value of 81 before RT. Mean anxiety score in children measured by C1 of STAIC was 48 and 40 respectively, which improved significantly to mean values of 30 and 26, respectively at 24 month follow up assessment (p=0.005). Mean depression score in patients aged more than 16 years was 23 at baseline, which improved to 17 and 14 at 6 and 24 months follow up assessments, respectively. Conclusions: Our data demonstrates neuropsychological impairment in a cohort of young patients with benign and low-grade tumors even before starting radiotherapy. SCRT however did not result in any further worsening, the encouraging results of which need to be validated in larger number of patients at a longer follow up.