183 - 10-Year Neuropsychological and QoL Outcomes in Pediatric Brain Tumor Survivors: A Comparison of Photon and Proton Cohorts
Presenter(s)
B. R. Eaton1, M. B. Pulsifer2, G. Fong3, L. Ingerski3, K. W. Allison4, B. Bajaj4, M. P. Lawell4, S. L. Dennehy5, A. Perry4, B. Y. Yeap6, C. Kirk3, L. Wiltsie7, D. H. Ebb7, T. MacDonald3, N. Esiashvili1, and T. I. Yock8; 1Department of Radiation Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, 2Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 3Children's Healthcare of Atlanta, Atlanta, GA, 4Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 5Massachusetts General Hospital, Boston, MA, 6Department of Biostatistics, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 7Department of Pediatric Hematology & Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 8Department of Radiation Oncology, Mass General Brigham, Harvard Medical School, Boston, MA
Purpose/Objective(s):
Proton radiotherapy (RT) treats less normal brain tissue compared to photon RT. Therefore, we hypothesize that pediatric brain tumor survivors (PBTS) treated with protons should have improved neuropsychological and quality of life (QOL) outcomes compared with contemporaneously photon treated PBTS. This study compares latest neuropsychological and QoL outcomes in PBTS treated with photon or proton RT.Materials/Methods:
PBTS treated with protons or photons from two US institutions were consented to participate in this prospective trial and given neuropsychological evaluations, PedsQL Core and Fatigue surveys, and a medical evaluation to fully catalog current medical problems. Neuropsychological testing was conducted using standardized age-based measures to assess multiple domains of functioning, including intelligence, memory, attention, academic skills, and adaptive, executive and emotional/behavioral functioning. Statistical analysis compared proton and photon cohort outcomes.Results:
102 (67 proton, 35 photon) patients were enrolled and received neuropsychological testing. Most had medulloblastoma (60.7%) or ependymoma (30.4%) and patients were well matched for histology, age, treatment exposures, gender, and treatment era. Median age radiotherapy for the photon and proton cohorts was 7.5 years and 7.7 years, respectively. Median follow-up from RT was 9.8 years (photons) and 10.6 years (protons). The proton cohort scored significantly higher than the photon cohort for Full Scale IQ (FSIQ), Verbal Comprehension, Working Memory, and Perceptual Reasoning with mean differences of 12, 14, 9, and 9 points, respectively. The proton cohort trended higher for Processing Speed by a mean of 6 points (p=0.09). FSIQ mean scores were in the average and high average range for 32% and 3% (total 35%) for the photon cohort, and 46% and 13% (total 59%) for the proton cohort. Proton survivors also scored significantly better in measures of verbal memory, attention, and adaptive functioning. PedsQL Summary Scores for photon and proton cohorts are the following at follow-up (where higher scores are better): Total 72.1 vs 78.9, p=0.08; Physical 69.7 vs 80.6, p=0.03; Psychosocial 73.4 vs 78, p=0.20; Fatigue 61.2 vs 68.5, p=0.10).Conclusion:
A decade after treatment, the proton-treated PBTS had higher scores on neuropsychological testing, including the FSIQ, working memory, attention, verbal memory, and adaptive functioning and a greater proportion remained in the average or higher range for FSIQ. The PedsQL summary scores for the proton cohort trended higher than in the photon cohort, but only the physical summary score reached significance. When reasonable, proton radiotherapy should be employed in children with curable brain tumors to ameliorate late neuropsychological effects of radiation and improve patient reported QoL.