title: Early Cognitive Outcomes Following Proton Radiation in Pediatric Patients With Brain and Central Nervous System Tumors.
abstract: OBJECTIVE
  To report, from a longitudinal study, cognitive outcome in pediatric patients treated with proton radiation therapy (PRT) for central nervous system (CNS) tumors.
  
  
  METHODS
  Sixty patients receiving PRT for medulloblastoma (38.3%), gliomas (18.3%), craniopharyngioma (15.0%), ependymoma (11.7%), and other CNS tumors (16.7%) were administered age-appropriate measures of cognitive abilities at or near PRT initiation (baseline) and afterward (follow-up). Patients were aged ≥ 6 years at baseline to ensure consistency in neurocognitive measures.
  
  
  RESULTS
  Mean age was 12.3 years at baseline; mean follow-up interval was 2.5 years. Treatment included prior surgical resection (76.7%) and chemotherapy (61.7%). Proton radiation therapy included craniospinal irradiation (46.7%) and partial brain radiation (53.3%). At baseline, mean Wechsler Full Scale IQ was 104.6; means of all 4 Index scores were also in the average range. At follow-up, no significant change was observed in mean Wechsler Full Scale IQ, Verbal Comprehension, Perceptual Reasoning/Organization, or Working Memory. However, Processing Speed scores declined significantly (mean 5.2 points), with a significantly greater decline for subjects aged <12 years at baseline and those with the highest baseline scores. Cognitive outcome was not significantly related to gender, extent of radiation, radiation dose, tumor location, histology, socioeconomic status, chemotherapy, or history of surgical resection.
  
  
  CONCLUSIONS
  Early cognitive outcomes after PRT for pediatric CNS tumors are encouraging, compared with published outcomes from photon radiation therapy.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: mpulsifer@mgh.harvard.edu.
authors.forename: Margaret B
authors.initials: MB
authors.lastname: Pulsifer
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Roshan V
authors.initials: RV
authors.lastname: Sethi
authors.affiliation: Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Karen A
authors.initials: KA
authors.lastname: Kuhlthau
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: MacDonald
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Nancy J
authors.initials: NJ
authors.lastname: Tarbell
authors.affiliation: Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Torunn I
authors.initials: TI
authors.lastname: Yock
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000532:radiotherapy; D016543:Central Nervous System Neoplasms / Q000532:radiotherapy*; D002648:Child; D003071:Cognition / Q000528:radiation effects*; D032882:Comprehension / Q000528:radiation effects; D061888:Craniospinal Irradiation / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007360:Intelligence / Q000528:radiation effects; D008297:Male; D008527:Medulloblastoma / Q000532:radiotherapy; D008570:Memory, Short-Term / Q000528:radiation effects; D061766:Proton Therapy / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult