Thomas E Merchant1, Shelly Sharma2, Xiaoping Xiong3, Shengjie Wu3, Heather Conklin4. 1. Division of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. Electronic address: thomas.merchant@stjude.org. 2. Division of Radiation Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee. 3. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee. 4. Department of Psychology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Abstract
PURPOSE: Cognitive decline is a recognized effect of radiation therapy (RT) in children treated for brain tumors. The importance of the cerebellum and its contribution to cognition have been recognized; however, the effect of RT on cerebellum-linked neurocognitive deficits has yet to be explored. METHODS AND MATERIALS: Seventy-six children (39 males) at a median 3.3 years of age (range, 1-17 years old) were irradiated for infratentorial ependymoma from 1997 to 2008. The total prescribed dose was 54 to 59.4 Gy administered to the postoperative tumor bed with 5- or 10-mm clinical target volume margin. Age-appropriate cognitive and academic testing was performed prior to the start of RT and was then repeated at 6 months and annually throughout 5 years. The anterior and posterior cerebellum and other normal brain volumes were contoured on postcontrast, T1-weighted postoperative magnetic resonance images registered to treatment planning computed tomography images. Mean doses were calculated and used with time after RT and other clinical covariates to model their effect on neurocognitive test scores. RESULTS: Considering only the statistically significant rates in longitudinal changes for test scores and models that included mean dose, there was a correlation between mean infratentorial dose and intelligence quotient (IQ; -0.190 patients/Gy/year; P=.001), math (-0.164 patients/Gy/year; P=.010), reading (-0.137 patients/Gy/year; P=.011), and spelling scores (-0.147 patients/Gy/year; P=.012), where Gy was measured as the difference between the mean dose received by an individual patient and the mean dose received by the patient group. There was a correlation between mean anterior cerebellum dose and IQ scores (-0.116 patients/Gy/year; P=.042) and mean posterior cerebellum dose and IQ (-0.150 patients/Gy/year; P=.002), math (-0.120 patients/Gy/year; P=.023), reading (-0.111 patients/Gy/year; P=.012), and spelling (-0.117 patients/Gy/year; P=.015) scores. CONCLUSIONS: Sparing portions of the cerebellum should be considered in RT planning for children with infratentorial ependymoma because of the potential impact of radiation dose on cognitive function.
PURPOSE:Cognitive decline is a recognized effect of radiation therapy (RT) in children treated for brain tumors. The importance of the cerebellum and its contribution to cognition have been recognized; however, the effect of RT on cerebellum-linked neurocognitive deficits has yet to be explored. METHODS AND MATERIALS: Seventy-six children (39 males) at a median 3.3 years of age (range, 1-17 years old) were irradiated for infratentorial ependymoma from 1997 to 2008. The total prescribed dose was 54 to 59.4 Gy administered to the postoperative tumor bed with 5- or 10-mm clinical target volume margin. Age-appropriate cognitive and academic testing was performed prior to the start of RT and was then repeated at 6 months and annually throughout 5 years. The anterior and posterior cerebellum and other normal brain volumes were contoured on postcontrast, T1-weighted postoperative magnetic resonance images registered to treatment planning computed tomography images. Mean doses were calculated and used with time after RT and other clinical covariates to model their effect on neurocognitive test scores. RESULTS: Considering only the statistically significant rates in longitudinal changes for test scores and models that included mean dose, there was a correlation between mean infratentorial dose and intelligence quotient (IQ; -0.190 patients/Gy/year; P=.001), math (-0.164 patients/Gy/year; P=.010), reading (-0.137 patients/Gy/year; P=.011), and spelling scores (-0.147 patients/Gy/year; P=.012), where Gy was measured as the difference between the mean dose received by an individual patient and the mean dose received by the patient group. There was a correlation between mean anterior cerebellum dose and IQ scores (-0.116 patients/Gy/year; P=.042) and mean posterior cerebellum dose and IQ (-0.150 patients/Gy/year; P=.002), math (-0.120 patients/Gy/year; P=.023), reading (-0.111 patients/Gy/year; P=.012), and spelling (-0.117 patients/Gy/year; P=.015) scores. CONCLUSIONS: Sparing portions of the cerebellum should be considered in RT planning for children with infratentorial ependymoma because of the potential impact of radiation dose on cognitive function.
Authors: R G Steen; M Koury B S; C I Granja; X Xiong; S Wu; J O Glass; R K Mulhern; L E Kun; T E Merchant Journal: Int J Radiat Oncol Biol Phys Date: 2001-01-01 Impact factor: 7.038
Authors: Thomas E Merchant; Raymond K Mulhern; Matthew J Krasin; Larry E Kun; Tani Williams; Chenghong Li; Xiaoping Xiong; Raja B Khan; Robert H Lustig; Frederick A Boop; Robert A Sanford Journal: J Clin Oncol Date: 2004-08-01 Impact factor: 44.544
Authors: David M Ashley; Thomas E Merchant; Douglas Strother; Tianni Zhou; Patricia Duffner; Peter C Burger; Douglas C Miller; Nancy Lyon; Melanie J Bonner; Michael Msall; Allen Buxton; Russell Geyer; Larry E Kun; Lee Coleman; Ian F Pollack Journal: J Clin Oncol Date: 2012-07-30 Impact factor: 44.544
Authors: Michal Zapotocky; Kiran Beera; Jenny Adamski; Normand Laperierre; Sharon Guger; Laura Janzen; Alvaro Lassaletta; Liana Figueiredo Nobre; Ute Bartels; Uri Tabori; Cynthia Hawkins; Stacey Urbach; Derek S Tsang; Peter B Dirks; Michael D Taylor; Eric Bouffet; Donald J Mabbott; Vijay Ramaswamy Journal: Cancer Date: 2019-02-15 Impact factor: 6.860
Authors: Thomas E Merchant; Anne E Bendel; Noah D Sabin; Peter C Burger; Dennis W Shaw; Eric Chang; Shengjie Wu; Tianni Zhou; David D Eisenstat; Nicholas K Foreman; Christine E Fuller; Edwina Templeton Anderson; Juliette Hukin; Ching C Lau; Ian F Pollack; Fred H Laningham; Robert H Lustig; Floyd D Armstrong; Michael H Handler; Chris Williams-Hughes; Sandra Kessel; Mehmet Kocak; David W Ellison; Vijay Ramaswamy Journal: J Clin Oncol Date: 2019-02-27 Impact factor: 44.544
Authors: Derek S Tsang; Laurence Kim; Zhihui Amy Liu; Laura Janzen; Mohammad Khandwala; Eric Bouffet; Normand Laperriere; Hitesh Dama; Dana Keilty; Tim Craig; Vijay Ramaswamy; David C Hodgson; Donald Mabbott Journal: Neuro Oncol Date: 2021-03-25 Impact factor: 12.300
Authors: Tara M Brinkman; Matthew J Krasin; Wei Liu; Gregory T Armstrong; Rohit P Ojha; Zsila S Sadighi; Pankaj Gupta; Cara Kimberg; Deokumar Srivastava; Thomas E Merchant; Amar Gajjar; Leslie L Robison; Melissa M Hudson; Kevin R Krull Journal: J Clin Oncol Date: 2016-02-01 Impact factor: 44.544
Authors: Shahed N Badiyan; Stephan Ulmer; Frank J Ahlhelm; Anna S M Fredh; Ulrike Kliebsch; Gabriele Calaminus; Alessandra Bolsi; Francesca Albertini; Dominic Leiser; Beate Timmermann; Robert S Malyapa; Ralf Schneider; Antony J Lomax; Damien C Weber Journal: Int J Part Ther Date: 2017-07-11
Authors: Victoria A Torres; Jason M Ashford; Evelyn Wright; Jiahui Xu; Hui Zhang; Thomas E Merchant; Heather M Conklin Journal: Neuro Oncol Date: 2021-07-01 Impact factor: 12.300
Authors: Ade Oyefiade; Iris Paltin; Cinzia R De Luca; Kristina K Hardy; David R Grosshans; Murali Chintagumpala; Donald J Mabbott; Lisa S Kahalley Journal: J Clin Oncol Date: 2021-04-22 Impact factor: 50.717