Thomas Tina, Witt Mary E, Evans Casey L, Grieco Julie A, Yock Torunn I, Pulsifer Margaret B
Division of Pediatric Neuropsychology, Children's National Hospital, Washington, DC, USA.
Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, Washington, DC, USA.
Childs Nerv Syst. 2025 Jun 24;41(1):217. doi: 10.1007/s00381-025-06876-4.
Pediatric brain tumor survivors (PBTS) treated with radiation at a very young age are at risk for adverse neuropsychological outcomes. This retrospective cross-sectional study examined outcomes and educational service utilization in 45 PBTS treated with proton radiation therapy (PRT) before age 4.
PBTS and their parents were administered measures at ≥ 1 year post-PRT. Areas assessed: intelligence, emotional, behavioral, adaptive, and executive functioning. Age-based scores were compared to normative means, rates of impairment were calculated, and demographic/clinical factors and educational service utilization were examined.
Median age at PRT was 2.58 years. Median interval to follow-up was 2.42 years. All received daily anesthesia during PRT and most received focal PRT (88.9%), had infratentorial tumors (71.1%), received chemotherapy (62.2%), and had sensory/motor deficits (51.1%). All mean standard/T-scores were in the average range. However, mean scores were significantly different from normative data and rates of impairment were notably elevated in withdrawal, anxiety, activities of daily living, shifting, working memory, and adaptive skills. Mean scores and rates of impairment were significantly lower (fewer problems) in aggression and conduct problems. Scores were comparable to the norm in attention, hyperactivity, depression, social skills, inhibition, and emotional control. More than half (62.2%) received special education services/accommodations; patients with sensory/motor deficits received more services/accommodations. Gender, tumor location, chemotherapy, and socioeconomic status were not significantly related to outcome.
Neuropsychological outcomes for PBTS treated with PRT before age 4 are encouraging, although there are some areas of concern. Yearly screening, proactive intervention for executive/psychological/adaptive functioning, and special education services/accommodations are recommended.
在非常年幼时接受放疗的小儿脑肿瘤幸存者（PBTS）有出现不良神经心理结局的风险。这项回顾性横断面研究调查了45名4岁前接受质子放射治疗（PRT）的PBTS的结局和教育服务利用情况。
在PRT后≥1年对PBTS及其父母进行测评。评估的领域包括：智力、情绪、行为、适应性和执行功能。将基于年龄的分数与常模均值进行比较，计算损伤率，并检查人口统计学/临床因素和教育服务利用情况。
PRT时的中位年龄为2.58岁。中位随访间隔为2.42年。所有人在PRT期间均接受每日麻醉，大多数接受局部PRT（88.9%），患有幕下肿瘤（71.1%），接受化疗（62.2%），并有感觉/运动缺陷（51.1%）。所有平均标准/T分数均在平均范围内。然而，平均分数与常模数据有显著差异，在退缩、焦虑、日常生活活动、转换、工作记忆和适应性技能方面损伤率明显升高。在攻击和品行问题方面，平均分数和损伤率显著较低（问题较少）。在注意力、多动、抑郁、社交技能、抑制和情绪控制方面，分数与常模相当。超过一半（62.2%）的人接受了特殊教育服务/便利措施；有感觉/运动缺陷的患者接受了更多的服务/便利措施。性别、肿瘤位置、化疗和社会经济地位与结局无显著相关性。
4岁前接受PRT治疗的PBTS的神经心理结局令人鼓舞，尽管仍有一些令人担忧的领域。建议每年进行筛查，对执行/心理/适应性功能进行积极干预，并提供特殊教育服务/便利措施。
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