Impairment of intellectual functions after surgery and posterior fossa irradiation in children with ependymoma is related to age and neurologic complications.
BACKGROUND
To investigate the neuropsychological outcome of children treated with surgery and posterior fossa irradiation for localized infratentorial ependymoma.


METHODS
23 patients (age 0.3 - 14 years at diagnosis) who were treated with local posterior fossa irradiation (54 Gy) underwent one (4 patients) or sequential (19 patients) neuropsychologic evaluation. The last evaluation was performed at a median of 4.5 (1 to 15.5) years after RT.


RESULTS
Mean last full scale IQ (FSIQ), verbal IQ (VIQ) and PIQ were 89.1, 94.0, and 86.2 respectively. All patients had difficulties with reading, and individual patients showed deficits in visuospatial, memory and attentional tasks. There was no trend for deterioration of intellectual outcome over time. All 5 children with IQ scores < or = 75 were under the age of four at diagnosis. There was a significant association between the presence of cerebellar deficits and impaired IQ (72.0 vs 95.2, p < 0,001). The absence of hydrocephalus was an indicator of better neuropsychologic outcome (mean FSIQ of 102.6 vs 83.9, p = 0.025).


CONCLUSIONS
Within the evaluated cohort, intellectual functions were moderately impaired. Markedly reduced IQ scores were only seen with early disease manifestation and treatment, and postoperative neurological deficits had a strong impact on intellectual outcome.
von Hoff
Katja
K
Department of paediatric and adolescent oncology, Gustave Roussy institute, 39 rue Camille Desmoulins, 94805 Villejuif cedex, France. hoff_k@klinik.uni-wuerzburg.de
Kieffer
Virginie
V
Habrand
Jean-Louis
JL
Kalifa
Chantal
C
Dellatolas
Georges
G
Grill
Jacques
J
D000293:Adolescent; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004700:Endocrine System Diseases / Q000209:etiology / Q000523:psychology; D004806:Ependymoma / Q000150:complications / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D015192:Infratentorial Neoplasms / Q000523:psychology* / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D007360:Intelligence; D007361:Intelligence Tests; D008297:Male; D020362:Paraneoplastic Cerebellar Degeneration / Q000209:etiology / Q000523:psychology; D012307:Risk Factors