title: Therapeutic schedules influence the pattern of intellectual decline after irradiation of posterior fossa tumors.
abstract: BACKGROUND
  To evaluate intellectual decline in children with posterior fossa (PF) tumors treated with different therapeutic protocols.
  
  
  METHODS
  Forty children had a complete neuropsychological evaluation prospectively twice, at least 6 months year (y) after the end of their treatment. Patients were classified into four groups according to treatment schedules: Group 1 (n = 7) PF radiotherapy (PFRT) alone at 50 Gy; Group 2 (n = 13) reduced-dose cranio-spinal irradiation (CSI) at 25 Gy with a PF boost; Group 3 (n = 9) standard CSI at 35 Gy and a PF boost; and Group 4 (n = 11) high-dose chemotherapy with stem cell support followed by PFRT at 50 Gy.
  
  
  RESULTS
  At the first evaluation (mean interval since diagnosis 3.7 y), the mean Full-Scale Intellectual Quotient (FSIQ) was 80 (SD = 19). Only patients in Group 1 had a normal mean IQ score of 92 (SD = 14). At the second evaluation (mean interval since diagnosis 6.3 y), the mean FSIQ scores were significantly lower with a mean difference of 2.4 points, i.e., a yearly decline of one point. The magnitude of the FSIQ decline was positively correlated with the first IQ score (P = 0.0001) and inversely correlated with age at diagnosis (P = 0.0005). A FSIQ decline was observed in all treatment groups except Group 1 (P = 0.005). The differences in FSIQ observed initially between the four treatment groups persisted at the second evaluation.
  
  
  CONCLUSIONS
  This study shows that FSIQ continues to decline more than 4 years after the diagnosis but this yearly decline seems to decrease with time from diagnosis. Therapeutic schedules influence the magnitude of this decline. Long-term follow-up into adulthood is necessary to effectively adapt patient rehabilitation.
authors.affiliation: Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Kieffer-Renaux
authors.forename: Delphine
authors.initials: D
authors.lastname: Viguier
authors.forename: Marie-Anne
authors.initials: MA
authors.lastname: Raquin
authors.forename: Anne
authors.initials: A
authors.lastname: Laurent-Vannier
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Habrand
authors.forename: Georges
authors.initials: G
authors.lastname: Dellatolas
authors.forename: Chantal
authors.initials: C
authors.lastname: Kalifa
authors.forename: Olivier
authors.initials: O
authors.lastname: Hartmann
authors.forename: Jacques
authors.initials: J
authors.lastname: Grill
mesh_terms: D000293:Adolescent; D000328:Adult; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D003131:Combined Modality Therapy; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D007360:Intelligence / Q000528:radiation effects*; D007361:Intelligence Tests; D008297:Male; D011878:Radiotherapy / Q000009:adverse effects*; D013997:Time Factors