Research article

Impairment of intellectual functions after surgery and posterior fossa irradiation in children with ependymoma is related to age and neurologic complications

Katja von Hoff^1,2 , Virginie Kieffer^1,3 , Jean-Louis Habrand⁴ , Chantal Kalifa¹ , Georges Dellatolas⁵ and Jacques Grill¹

¹Department of paediatric and adolescent oncology, Gustave Roussy institute, 39 rue Camille Desmoulins, 94805 Villejuif cedex, France

²Childrens university hospital Wuerzburg, Josef-Schneider str.2, 97080 Wuerzburg, Germany

³Ressource center for patients with brain injuries, national rehabilitation hospital, 14 rue du val d'Osne, 94415 Saint-Maurice, France

⁴Department of radiotherapy, Gustave Roussy institute, 39 rue Camille Desmoulins, 94805 Villejuif cedex, France

⁵Laboratory of psychology and cognitive neurosciences, CNRS-FRE 2987, 71 avenue Edouard Vaillant, 92774 Boulogne-Billancourt, France

author email corresponding author email

BMC Cancer 2008, 8:15doi:10.1186/1471-2407-8-15

Published:	21 January 2008

Abstract

Background

To investigate the neuropsychological outcome of children treated with surgery and posterior fossa irradiation for localized infratentorial ependymoma.

Methods

23 patients (age 0.3 – 14 years at diagnosis) who were treated with local posterior fossa irradiation (54 Gy) underwent one (4 patients) or sequential (19 patients) neuropsychologic evaluation. The last evaluation was performed at a median of 4.5 (1 to 15.5) years after RT.

Results

Mean last full scale IQ (FSIQ), verbal IQ (VIQ) and PIQ were 89.1, 94.0, and 86.2 respectively. All patients had difficulties with reading, and individual patients showed deficits in visuospatial, memory and attentional tasks. There was no trend for deterioration of intellectual outcome over time. All 5 children with IQ scores ≤ 75 were under the age of four at diagnosis. There was a significant association between the presence of cerebellar deficits and impaired IQ (72.0 vs 95.2, p < 0,001). The absence of hydrocephalus was an indicator of better neuropsychologic outcome (mean FSIQ of 102.6 vs 83.9, p = 0.025).

Conclusion

Within the evaluated cohort, intellectual functions were moderately impaired. Markedly reduced IQ scores were only seen with early disease manifestation and treatment, and postoperative neurological deficits had a strong impact on intellectual outcome.