RONC-03. NEUROCOGNITIVE CHANGES AFTER RADIATION FOR PEDIATRIC BRAIN TUMOURS: WHICH BRAIN SUBSTRUCTURES ARE MOST IMPORTANT?

Abstract

INTRODUCTIONThe contribution of different intracranial structures on neurocognitive decline after radiation therapy (RT) in children is unclear.METHODSThis was a retrospective study of children with brain tumours treated from 2005 to 2017. Patients with longitudinal neurocognitive assessments and photon dosimetric data (if RT given) were included. Full scale intelligence quotient (FSIQ) was the primary endpoint; sub-indices of neurocognition were modelled separately (perceptual reasoning [PRI], processing speed [PSI], verbal comprehension [VCI] and working memory [WMI]). Multivariable linear mixed effects models were used to model endpoints, with age at diagnosis & dose to different brain regions as fixed effects and patient-specific random intercepts.RESULTSSixty-nine patients were included; ten patients did not receive any RT (i.e. low-grade glioma). Median neurocognitive follow-up was 3.2 years. Right hippocampus mean dose was a strong predictor of declines in FSIQ (p < .001), VCI (p = 0.002) and PRI (p = 0.049). Dose to 50% of the supratentorial brain (D50) was the strongest predictor for WMI (p < .001) and PSI (p < .001). Each gray increase in mean right hippocampus dose resulted in a decrease of 0.038 FSIQ points/year. After adjusting for dose to brain substructures, younger age & presence of a ventriculoperitoneal shunt were also associated with decreased FSIQ.CONCLUSIONSMean dose to the right hippocampus was associated with declines in FSIQ, VCI and PRI, while supratentorial brain D50 was associated with WMI and PSI. Efforts should be made to reduce unnecessary dose to these brain structures.