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Serial Evaluation of Academic and Behavioral Outcome After Treatment With Cranial Radiation in Childhood

From the Department of Psychology and Divisions of Hematology/Oncology and Neurosurgery, The Hospital for Sick Children; and Departments of Pediatrics and Surgery, University of Toronto, Toronto, Ontario, Canada

Address reprint requests to D. Mabbott, PhD, Paediatric Brain Tumor Program, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, M5G 1X8, Canada; e-mail: donald.mabbott{at}sickkids.ca

PURPOSE: To evaluate academic and behavioral outcome in radiated survivors of posterior fossa (PF) tumors.

PATIENTS AND METHODS: Fifty-three patients (36 males) treated for malignant PF tumors were seen for evaluation of academics and/or behavioral functioning. Forty-six patients were treated for medulloblastoma, and seven patients were treated for ependymoma. Fourteen patients were treated with reduced-dose cranial radiation, and 34 patients were treated with standard-dose cranial radiation (dose was not available for four patients). All patients received an additional boost to the PF. One patient was treated with PF radiation only. Standardized achievement tests and behavioral questionnaires were administered at different times after diagnosis for each child. First, the influence of demographic and medical variables on outcome was examined. Second, the rate of change in scores was determined using mixed model regression for patients seen for serial assessment.

RESULTS: The presence of hydrocephalus was related to poorer academics, but outcome was not related to radiation dose, extent of surgery, or treatment with chemotherapy. Younger age predicted poor reading ability and lower parent rating of academic achievement. Children's performance declined for spelling, mathematics, and reading. Significant declines were also evident in parent and teacher's ratings of academic ability. Behavioral functioning was generally not related to medical and demographic variables, and few clinically significant problems in externalizing behavior were evident. Increases in social and attention problems emerged over time.

CONCLUSION: Cranial radiation is associated with declines in academic ability, social skills, and attention. However, neither psychological distress nor behavior problems were a significant concern for this sample.

Presented in part at the 11th International Symposium on Pediatric Neuro-Oncology, International Society for Pediatric Neuro-Oncology, Boston, MA, June 13-16, 2004.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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