Abstract
Pediatric posterior fossa tumor (PFT) survivors who have been treated with cranial radiation therapy often suffer from cognitive impairments that might relate to IQ decline. Radiotherapy (RT) distinctly affects brain regions involved in different cognitive functions. However, the relative contribution of regional irradiation to the different cognitive impairments still remains unclear. We investigated the relationships between the changes in different cognitive scores and radiation dose distribution in 30 children treated for a PFT. Our exploratory analysis was based on a principal component analysis (PCA) and an ordinary least square regression approach. The use of a PCA was an innovative way to cluster correlated irradiated regions due to similar radiation therapy protocols across patients. Our results suggest an association between working memory decline and a high dose (equivalent uniform dose, EUD) delivered to the orbitofrontal regions, whereas the decline of processing speed seemed more related to EUD in the temporal lobes and posterior fossa. To identify regional effects of RT on cognitive functions may help to propose a rehabilitation program adapted to the risk of cognitive impairment.
Highlights
Posterior fossa tumors (PFTs) account for two-thirds of all pediatric brain tumors [1]
PFT’s Radiotherapy and Cognitive Decline seems to appear first in PFT patients treated with cranio-spinal irradiation (CSI) [4]
Three RT-associated risk factors have been highlighted as predictors of cognitive impairments: (i) CSI [6, 7, 10], (ii) the volume receiving the boost [i.e., to the posterior fossa (PF)] [11], and (iii) the dose per fraction [12, 13]
Summary
Posterior fossa tumors (PFTs) account for two-thirds of all pediatric brain tumors [1]. As a result of improved treatment, event-free survival has significantly increased [3] These children suffer from varied cognitive impairments, the most frequently described being decreased sustained attention, working memory, and information processing speed [4]. PFT’s Radiotherapy and Cognitive Decline seems to appear first in PFT patients treated with cranio-spinal irradiation (CSI) [4]. Three RT-associated risk factors have been highlighted as predictors of cognitive impairments: (i) CSI [6, 7, 10], (ii) the volume receiving the boost [i.e., to the posterior fossa (PF)] [11], and (iii) the dose per fraction [12, 13]. Medulloblastoma survivors treated via either a CSI dose reduction or a diminution of PF volume irradiated (tumor bed boost) still experienced a decline of IQ
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