INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #104 Learning and Memory Performance in Children and Adolescents with Craniopharyngioma Treated with Proton Radiotherapy Bethany Schwandt, St. Jude Children's Research Hospital, Memphis, United States Jason Ashford, St. Jude Children's Research Hospital, Memphis, United States Jia Liang, St. Jude Children's Research Hospital, Memphis, United States Yimei Li, St. Jude Children's Research Hospital, Memphis, United States Niki Jurbergs, St. Jude Children's Research Hospital, Memphis, United States Thomas Merchant, St. Jude Children's Research Hospital, Memphis, United States Heather Conklin, St. Jude Children's Research Hospital, Memphis, United States Category: Cancer Keyword 1: brain tumor Keyword 2: radiotherapy Keyword 3: cognitive functioning Objective: Craniopharyngioma is a histologically benign tumor arising in the suprasellar brain region that may impact the hypothalamic-pituitary axis, visual pathways, and central vasculature. We previously reported significant memory deficits in children and adolescents treated for craniopharyngioma after surgery and prior to proton radiotherapy (PRT). The purpose of the present study was to investigate memory performance following PRT, including evaluation of risk factors, using longitudinal analyses and latent profile analysis. Participants and Methods: From August 2011 to May 2016 patients were enrolled on a phase II trial of limited surgery and PRT or observation after radical resection for craniopharyngioma (RT2CR; NCT01419067). Patients included infants through 21 years of age, newly diagnosed with craniopharyngioma by histology, cytology or neuroimaging (N=97). Patients who received less than gross total resection (GTR) or no surgical resection were treated with passively-scattered PRT (n = 91) or observation after radical resection without PRT (n = 6). Total cumulative dose was 54CGE using daily fractions of 1.8CGE and a 5 mm clinical target volume. Participants underwent serial cognitive evaluations including the California Verbal Learning Test (CVLT) at 3 time points (baseline prior to initiation of PRT, 24 and 48 months). CVLT overall T score (Trials 1-5) and select Z scores were analyzed. Linear mixed models were used to examine change in CVLT performance over time. Clinical and demographic variables were added to the models as univariate covariates. Latent class analyses (LCA) were used to identify isolated patterns of protective and risk factors for select CVLT scores. Results: Linear mixed models indicated there was no decline for any CVLT indices from baseline to year 2 and 4 (ps= 0.32-0.69). Compared with the time trend of the no-surgery group (n=11), memory declined 2.7 points per year in the subset of patients with more than 2 surgeries (n = 15; CVLT Total, p=0.0419). Compared to the group without CSF diversion, memory improved in patients with CSF diversion (CVLT, Long Delay Free and Cued, P<0.05). Patients with greater preoperative hypothalamic involvement (HI) showed improvement in memory (CVLT, Total and Long Delay Cued Recall, P<0.05) compared to patients with less HI. The LCA model did not reveal more than one latent class for memory performance (CVLT Total or CVLT Long Delay Free Recall). Conclusions: Findings suggest children and adolescents treated for craniopharyngioma experience memory impairment prior to adjuvant therapy due to tumor mass effect and surgical intervention. Patients do not appear to demonstrate additional declines associated with PRT. Results from the current study support the benefits of PRT, which offers greater sparing of healthy brain tissue than photon radiation therapy. Additionally, CSF diversion for hydrocephalus has a positive impact, when indicated; whereas, multiple surgeries incur memory risk. Further, there do not appear to be underlying subgroups of patients whose memory performance was more or less impacted by different clinical intervention (e.g., extent of surgery) over time. Taken together, these findings may assist in treatment planning, cognitive monitoring recommendations, caregiver education and development of interventions.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #104

Learning and Memory Performance in Children and Adolescents with Craniopharyngioma Treated with Proton Radiotherapy

Bethany Schwandt, St. Jude Children's Research Hospital, Memphis, United States
Jason Ashford, St. Jude Children's Research Hospital, Memphis, United States
Jia Liang, St. Jude Children's Research Hospital, Memphis, United States
Yimei Li, St. Jude Children's Research Hospital, Memphis, United States
Niki Jurbergs, St. Jude Children's Research Hospital, Memphis, United States
Thomas Merchant, St. Jude Children's Research Hospital, Memphis, United States
Heather Conklin, St. Jude Children's Research Hospital, Memphis, United States

Category: Cancer

Keyword 1: brain tumor
Keyword 2: radiotherapy
Keyword 3: cognitive functioning

Objective:

Craniopharyngioma is a histologically benign tumor arising in the suprasellar brain region that may impact the hypothalamic-pituitary axis, visual pathways, and central vasculature. We previously reported significant memory deficits in children and adolescents treated for craniopharyngioma after surgery and prior to proton radiotherapy (PRT). The purpose of the present study was to investigate memory performance following PRT, including evaluation of risk factors, using longitudinal analyses and latent profile analysis.

Participants and Methods:

From August 2011 to May 2016 patients were enrolled on a phase II trial of limited surgery and PRT or observation after radical resection for craniopharyngioma (RT2CR; NCT01419067). Patients included infants through 21 years of age, newly diagnosed with craniopharyngioma by histology, cytology or neuroimaging (N=97). Patients who received less than gross total resection (GTR) or no surgical resection were treated with passively-scattered PRT (n = 91) or observation after radical resection without PRT (n = 6). Total cumulative dose was 54CGE using daily fractions of 1.8CGE and a 5 mm clinical target volume. Participants underwent serial cognitive evaluations including the California Verbal Learning Test (CVLT) at 3 time points (baseline prior to initiation of PRT, 24 and 48 months). CVLT overall T score (Trials 1-5) and select Z scores were analyzed. Linear mixed models were used to examine change in CVLT performance over time. Clinical and demographic variables were added to the models as univariate covariates. Latent class analyses (LCA) were used to identify isolated patterns of protective and risk factors for select CVLT scores.

Results:

Linear mixed models indicated there was no decline for any CVLT indices from baseline to year 2 and 4 (ps= 0.32-0.69). Compared with the time trend of the no-surgery group (n=11), memory declined 2.7 points per year in the subset of patients with more than 2 surgeries (n = 15; CVLT Total, p=0.0419). Compared to the group without CSF diversion, memory improved in patients with CSF diversion (CVLT, Long Delay Free and Cued, P<0.05). Patients with greater preoperative hypothalamic involvement (HI) showed improvement in memory (CVLT, Total and Long Delay Cued Recall, P<0.05) compared to patients with less HI. The LCA model did not reveal more than one latent class for memory performance (CVLT Total or CVLT Long Delay Free Recall).

Conclusions:

Findings suggest children and adolescents treated for craniopharyngioma experience memory impairment prior to adjuvant therapy due to tumor mass effect and surgical intervention. Patients do not appear to demonstrate additional declines associated with PRT. Results from the current study support the benefits of PRT, which offers greater sparing of healthy brain tissue than photon radiation therapy. Additionally, CSF diversion for hydrocephalus has a positive impact, when indicated; whereas, multiple surgeries incur memory risk. Further, there do not appear to be underlying subgroups of patients whose memory performance was more or less impacted by different clinical intervention (e.g., extent of surgery) over time. Taken together, these findings may assist in treatment planning, cognitive monitoring recommendations, caregiver education and development of interventions.