The importance of factors other than the amount of radiation received (such as postoperative complications, the direct effects of the tumor, or the effects of associated hydrocephalus on mentation) has not been assessed by most studies and almost all reports of cognitive dysfunction in patients surviving brain tumors have been retrospective in nature.23,24 Despite this, based on the information available, attempts have been made to reduce the amount of radiation given.31 The reduction or deletion of such radiotherapy potentially places patients at higher risk for disease relapse and death. Clarification is needed concerning the incidence and severity of intellectual compromise in children with brain tumors receiving whole-brain radiotherapy, how much of this intellectual compromise is directly related to the radiotherapy, and what other factors may be responsible for cognitive deficits. To address these issues, a prospective neuropsychological study was begun in our institution in 1983 to evaluate all children who were treated with whole-brain radiotherapy for malignant brain tumors that did not directly involve the cerebral cortex. Cognitive function in these children was compared to function in children harboring tumors in similar sites in the CNS who had not received radiotherapy.
We thank Linda Cella for secretarial assistance.
This work was supported in part by the Foerderer Fund for Excellence: Neuro-Oncology, and the Eagles Fly for Leukemia Fund.
This paper was presented in part at the Annual Meeting of the Child Neurology Society, San Diego, California in October, 1987.