title: A 5-year investigation of children's adaptive functioning following conformal radiation therapy for localized ependymoma.
abstract: OBJECTIVE
  Conformal and intensity modulated radiation therapies have the potential to preserve cognitive outcomes in children with ependymoma; however, functional behavior remains uninvestigated. This longitudinal investigation prospectively examined intelligence quotient (IQ) and adaptive functioning during the first 5 years after irradiation in children diagnosed with ependymoma.
  
  
  METHODS
  The study cohort consisted of 123 children with intracranial ependymoma. Mean age at irradiation was 4.60 years (95% confidence interval [CI], 3.85-5.35). Serial neurocognitive evaluations, including an age-appropriate IQ measure and the Vineland Adaptive Behavior Scales (VABS), were completed before irradiation, 6 months after treatment, and annually for 5 years. A total of 579 neurocognitive evaluations were included in these analyses.
  
  
  RESULTS
  Baseline IQ and VABS were below normative means (P<.05), although within the average range. Linear mixed models revealed stable IQ and VABS across the follow-up period, except for the VABS Communication Index, which declined significantly (P=.015). Annual change in IQ (-.04 points) did not correlate with annual change in VABS (-.90 to +.44 points). Clinical factors associated with poorer baseline performance (P<.05) included preirradiation chemotherapy, cerebrospinal fluid shunt placement, number and extent of surgical resections, and younger age at treatment. No clinical factors significantly affected the rate of change in scores.
  
  
  CONCLUSIONS
  Conformal and intensity modulated radiation therapies provided relative sparing of functional outcomes including IQ and adaptive behaviors, even in very young children. Communication skills remained vulnerable and should be the target of preventive and rehabilitative interventions.
authors.affiliation: Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA.
authors.forename: Kelli L
authors.initials: KL
authors.lastname: Netson
authors.forename: Heather M
authors.initials: HM
authors.lastname: Conklin
authors.forename: Shengjie
authors.initials: S
authors.lastname: Wu
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Xiong
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Merchant
mesh_terms: D000223:Adaptation, Psychological / Q000528:radiation effects*; D000293:Adolescent; D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts; D002648:Child; D002675:Child, Preschool; D003071:Cognition / Q000528:radiation effects; D003142:Communication; D004806:Ependymoma / Q000188:drug therapy / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D006849:Hydrocephalus / Q000209:etiology; D007223:Infant; D007360:Intelligence / Q000528:radiation effects*; D016014:Linear Models; D008297:Male; D011446:Prospective Studies; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated; D013997:Time Factors; D055815:Young Adult