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Predicting Change in Academic Abilities After Conformal Radiation Therapy for Localized Ependymoma

Heather M. Conklin, Chenghong Li, Xiaoping Xiong, Robert J. Ogg, Thomas E. Merchant

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

Corresponding author: Heather M. Conklin, PhD, Division of Behavioral Medicine, St Jude Children's Research Hospital, 332 N Lauderdale St, Memphis, TN 38105-2794; e-mail: heather.conklin{at}stjude.org

Purpose Conformal radiation therapy (CRT) aims to limit the highest radiation dose to the tissue volume at risk while sparing surrounding normal tissues. This study investigated whether treatment of childhood ependymoma with CRT would preserve cognitive function. Academic competence was chosen as the primary outcome measure given it is a measure of applied cognitive abilities in a child's natural setting.

Patients and Methods Eighty-seven pediatric patients diagnosed with ependymoma received CRT in which doses ranging from 54.0 to 59.4 Gy were prescribed to the postoperative tumor bed with a 10-mm clinical target volume margin. Cognitive testing was conducted at the start of CRT, 6 months, and annually after the start of CRT. The median length of follow-up was 59.6 months. Academic testing included subtests from the Wechsler Individual Achievement Test (WIAT) and the Achenbach Child Behavior Checklist.

Results Linear mixed models with random coefficients revealed a modest but significant decline in reading scores during follow-up (WIAT slope estimate –0.064 ± 0.028 points/month; P = .026). Math and spelling performance remained stable. Supratentorial tumor location and multiple surgeries were predictive of worse reading performance at CRT baseline. Male sex, longer symptomatic interval, pre-CRT chemotherapy, pre-existing endocrine deficiencies, hydrocephalus, and younger age at CRT (< 5 years) were predictive of a significant decline in reading scores over time.

Conclusion CRT may result in better long-term cognitive outcomes when compared to conventional radiation therapy approaches. Reading appears more vulnerable than other academic skills and may decline over time despite stable intellectual functioning.

Supported in part by Cancer Center Support 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).

Presented in part at the International Neuropsychological Society in Portland, OR, February 7-10, 2007.

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

Clinical Trials repository link available on www.JCO.org.

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