Emotional and behavioral functioning after conformal radiation therapy for pediatric ependymoma.
OBJECTIVE
The standard of care for pediatric patients with ependymoma involves postoperative radiation therapy. Prior research suggests that conformal radiation therapy (CRT) is associated with relative sparing of cognitive and academic functioning, but little is known about the effect of CRT on emotional and behavioral functioning.


METHODS
A total of 113 patients with pediatric ependymoma underwent CRT using photons as part of their enrollment on an institutional trial. Patients completed annual evaluations of neurocognitive functioning during the first 5 years after CRT. Emotional and behavioral functioning was assessed via the Child Behavior Checklist.


RESULTS
Before CRT, emotional and behavioral functioning were commensurate with those of the normative population and within normal limits. After 5 years, means remained within normal limits but were significantly below the normative mean. Linear mixed models revealed a significant increase in attention problems over time. These problems were associated with age at diagnosis/CRT, tumor location, and extent of resection. A higher-than-expected incidence of school problems was present at all assessment points after baseline.


CONCLUSIONS
The use of photon CRT for ependymoma is associated with relatively stable emotional and behavioral functioning during the first 5 years after treatment. The exception is an increase in attention problems. Results suggest that intervening earlier in the survivorship period-during the first year posttreatment-may be beneficial.
Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Victoria W
VW
Willard
Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Heather M
HM
Conklin
Department of Surgery, St. Jude Children's Research Hospital, Memphis, Tennessee; Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, Memphis, Tennessee.
Frederick A
FA
Boop
Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee.
Shengjie
S
Wu
Division of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address: thomas.merchant@stjude.org.
Thomas E
TE
Merchant
D000293:Adolescent; D000367:Age Factors; D001288:Attention / Q000528:radiation effects; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology / Q000209:etiology*; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D004644:Emotions / Q000528:radiation effects*; D004806:Ependymoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D015192:Infratentorial Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D016014:Linear Models; D008297:Male; D009460:Neurologic Examination / Q000379:methods; D017785:Photons / Q000009:adverse effects / Q000627:therapeutic use; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D015173:Supratentorial Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery