Serial evaluation of academic and behavioral outcome after treatment with cranial radiation in childhood.
OBJECTIVE
To evaluate academic and behavioral outcome in radiated survivors of posterior fossa (PF) tumors.


METHODS
Fifty-three patients (36 males) treated for malignant PF tumors were seen for evaluation of academics and/or behavioral functioning. Forty-six patients were treated for medulloblastoma, and seven patients were treated for ependymoma. Fourteen patients were treated with reduced-dose cranial radiation, and 34 patients were treated with standard-dose cranial radiation (dose was not available for four patients). All patients received an additional boost to the PF. One patient was treated with PF radiation only. Standardized achievement tests and behavioral questionnaires were administered at different times after diagnosis for each child. First, the influence of demographic and medical variables on outcome was examined. Second, the rate of change in scores was determined using mixed model regression for patients seen for serial assessment.


RESULTS
The presence of hydrocephalus was related to poorer academics, but outcome was not related to radiation dose, extent of surgery, or treatment with chemotherapy. Younger age predicted poor reading ability and lower parent rating of academic achievement. Children's performance declined for spelling, mathematics, and reading. Significant declines were also evident in parent and teacher's ratings of academic ability. Behavioral functioning was generally not related to medical and demographic variables, and few clinically significant problems in externalizing behavior were evident. Increases in social and attention problems emerged over time.


CONCLUSIONS
Cranial radiation is associated with declines in academic ability, social skills, and attention. However, neither psychological distress nor behavior problems were a significant concern for this sample.
Mabbott
Donald J
DJ
Paediatric Brain Tumor Program, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada. donald.mabbott@sickkids.ca
Spiegler
Brenda J
BJ
Greenberg
Mark L
ML
Rutka
James T
JT
Hyder
Douglas J
DJ
Bouffet
Eric
E
D001288:Attention; D002648:Child; D002653:Child Behavior Disorders / Q000209:etiology*; D003072:Cognition Disorders / Q000209:etiology*; D004522:Educational Status; D004806:Ependymoma / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015192:Infratentorial Neoplasms / Q000532:radiotherapy*; D008297:Male; D008527:Medulloblastoma / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000523:psychology*; D012044:Regression Analysis; D012919:Social Behavior