title: Impact of craniospinal dose, boost volume, and neurologic complications on intellectual outcome in patients with medulloblastoma.
abstract: OBJECTIVE
  To examine the impact of radiation (ie, craniospinal irradiation [CSR] dose and boost volume) and complications (ie, hydrocephalus and other neurologic complications, including mutism) on patterns of change in intellectual functioning in medulloblastoma survivors.
  
  
  METHODS
  We conducted a retrospective review of 113 patients treated for medulloblastoma between 1983 and 2011 who were seen for neuropsychological assessment, including longitudinal follow-up of intellectual function. Patients were treated with either standard-dose CSR with a posterior fossa (PF) boost (n=51), standard-dose CSR plus tumor bed (TB) boost (n=9), reduced-dose CSR plus PF boost (n=28), or reduced-dose CSR plus TB boost (n=23), with or without chemotherapy. A subset of patients developed hydrocephalus that required cerebrospinal fluid (CSF) diversion (n=54) and/or other neurologic complications (n=40), more than half of which were postoperative mutism (n=25). Growth curve analysis was used to determine stability or change in intelligence scores over time.
  
  
  RESULTS
  Patients treated with reduced-dose CSR plus TB boost showed stable intellectual trajectories, whereas patients treated with higher doses and larger boost volumes experienced intellectual declines. Presence of complications was associated with worse intellectual outcome; however, hydrocephalus requiring CSF diversion and mutism differed in their pattern of decline.
  
  
  CONCLUSIONS
  These results improve our understanding of factors that impair intellectual outcome in patients treated for medulloblastoma. Lower doses of CSR and smaller boost volumes seem to mitigate intellectual decline. Our findings validate the use of TB boost and suggest PF boost should be reconsidered.
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Iska
authors: I
authors: Moxon-Emre
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Eric
authors: E
authors: Bouffet
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Michael D
authors: MD
authors: Taylor
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Normand
authors: N
authors: Laperriere
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Nadia
authors: N
authors: Scantlebury
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Nicole
authors: N
authors: Law
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Brenda J
authors: BJ
authors: Spiegler
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: David
authors: D
authors: Malkin
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
authors: Laura
authors: L
authors: Janzen
authors: Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada. donald.mabbott@sickkids.ca.
authors: Donald
authors: D
authors: Mabbott
mesh_terms: D000293:Adolescent; D002528:Cerebellar Neoplasms / Q000188:drug therapy / Q000523:psychology / Q000532:radiotherapy* / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D061888:Craniospinal Irradiation / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007360:Intelligence / Q000528:radiation effects*; D008137:Longitudinal Studies; D008297:Male; D008527:Medulloblastoma / Q000188:drug therapy / Q000523:psychology / Q000532:radiotherapy* / Q000628:therapy; D009422:Nervous System Diseases / Q000209:etiology* / Q000523:psychology; D011832:Radiation Injuries / Q000209:etiology* / Q000523:psychology; D011879:Radiotherapy Dosage; D012189:Retrospective Studies