Kieffer-Renaux Virginie, Viguier Delphine, Raquin Marie-Anne, Laurent-Vannier Anne, Habrand Jean-Louis, Dellatolas Georges, Kalifa Chantal, Hartmann Olivier, Grill Jacques
Department of Pediatric and Adolescent Oncology, Institut Gustave Roussy, Villejuif, France.
Pediatr Blood Cancer. 2005 Nov;45(6):814-9. doi: 10.1002/pbc.20329.
To evaluate intellectual decline in children with posterior fossa (PF) tumors treated with different therapeutic protocols.
Forty children had a complete neuropsychological evaluation prospectively twice, at least 6 months year (y) after the end of their treatment. Patients were classified into four groups according to treatment schedules: Group 1 (n = 7) PF radiotherapy (PFRT) alone at 50 Gy; Group 2 (n = 13) reduced-dose cranio-spinal irradiation (CSI) at 25 Gy with a PF boost; Group 3 (n = 9) standard CSI at 35 Gy and a PF boost; and Group 4 (n = 11) high-dose chemotherapy with stem cell support followed by PFRT at 50 Gy.
At the first evaluation (mean interval since diagnosis 3.7 y), the mean Full-Scale Intellectual Quotient (FSIQ) was 80 (SD = 19). Only patients in Group 1 had a normal mean IQ score of 92 (SD = 14). At the second evaluation (mean interval since diagnosis 6.3 y), the mean FSIQ scores were significantly lower with a mean difference of 2.4 points, i.e., a yearly decline of one point. The magnitude of the FSIQ decline was positively correlated with the first IQ score (P = 0.0001) and inversely correlated with age at diagnosis (P = 0.0005). A FSIQ decline was observed in all treatment groups except Group 1 (P = 0.005). The differences in FSIQ observed initially between the four treatment groups persisted at the second evaluation.
This study shows that FSIQ continues to decline more than 4 years after the diagnosis but this yearly decline seems to decrease with time from diagnosis. Therapeutic schedules influence the magnitude of this decline. Long-term follow-up into adulthood is necessary to effectively adapt patient rehabilitation.
评估采用不同治疗方案治疗的后颅窝（PF）肿瘤患儿的智力衰退情况。
40名儿童在治疗结束后至少6个月（年）（y）前瞻性地接受了两次完整的神经心理学评估。根据治疗方案将患者分为四组：第1组（n = 7）仅接受50 Gy的PF放射治疗（PFRT）；第2组（n = 13）接受25 Gy的减量全脑脊髓照射（CSI）并辅以PF增强照射；第3组（n = 9）接受35 Gy的标准CSI并辅以PF增强照射；第4组（n = 11）接受高剂量化疗并辅以干细胞支持，随后接受50 Gy的PFRT。
在首次评估时（自诊断起的平均间隔时间为3.7年），平均全量表智商（FSIQ）为80（标准差= 19）。只有第1组患者的平均智商得分正常，为92（标准差= 14）。在第二次评估时（自诊断起的平均间隔时间为6.3年），平均FSIQ得分显著降低，平均差异为2.4分，即每年下降1分。FSIQ下降的幅度与首次智商得分呈正相关（P = 0.0001），与诊断时的年龄呈负相关（P = 0.0005）。除第1组外，所有治疗组均观察到FSIQ下降（P = 0.005）。四个治疗组最初观察到的FSIQ差异在第二次评估时仍然存在。
本研究表明，FSIQ在诊断后4年多仍持续下降，但这种每年的下降似乎随着诊断时间的推移而减少。治疗方案会影响这种下降的幅度。对成年期进行长期随访对于有效调整患者康复至关重要。
