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Changes in Attentional Performance of Children and Young Adults With Localized Primary Brain Tumors After Conformal Radiation Therapy

Erin N. Kiehna, Raymond K. Mulhern, Chenghong Li, Xiaoping Xiong, Thomas E. Merchant

From the Divisions of Radiation Oncology and Behavioral Medicine, Department of Biostatistics, St Jude Children's Research Hospital, Memphis, TN
Deceased

Address reprint requests to Thomas E. Merchant, DO, PhD, Department of Radiological Sciences, MS 220, St Jude Children's Research Hospital, 332 N Lauderdale, Memphis, TN 38105-2794; e-mail: thomas.merchant{at}stjude.org

Purpose To prospectively assess the impact of conformal radiation therapy (CRT) and demographic and clinical variables on four measures of attention in pediatric and young adult patients with localized primary brain tumors.

Patients and Methods We prospectively evaluated 120 patients with primary brain tumors, ages 2 to 24.4 years (median, 9.2 years). Evaluations were done using the computerized Conners' Continuous Performance Test (CCPT). We analyzed errors of omission (inattentiveness), errors of commission (impulsivity), reaction time, and an overall index of performance before CRT, weekly during CRT, and serially up to 60 months after the start of CRT.

Results Before CRT, patients exhibited mild inattentiveness. During CRT, impulsivity decreased significantly (P = .002). After CRT, inattentiveness increased significantly (P = .03), and global attention disorders were associated with craniopharyngioma (P < .0001), supratentorial tumors (P = .008), optic pathway and diencephalic tumors (P = .012), and subtotal resection of the tumor (P = .010).

Conclusion Brain tumors and their treatment impair sustained attention and reaction time. A decline in impulsivity and relative stability of the other CCPT scores over the course of CRT demonstrated the absence of early radiation-related cognitive sequelae. Local tumor effects, initial surgical intervention, and focal irradiation of central structures contribute to long-lasting attentional problems in pediatric and young adult patients.

Supported by Cancer Center Grant No. CA21765 from the National Cancer Institute, by Research Project Grant No. RPG-99-252-01-CCE from the American Cancer Society, and by the American Lebanese Syrian Associated Charities (ALSAC).

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

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