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Neurocognitive function after radiotherapy for paediatric brain tumours

Nature Reviews Neurology volume 8, pages 578–588 (2012)Cite this article

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Abstract

The brain is highly vulnerable to neurotoxic agents during the prime learning period of a child's life. Paediatric patients with brain tumours who are treated with cranial radiation therapy (CRT) often go on to develop neurocognitive deficits, which are reflected in poor academic achievement and impaired memory, attention and processing speed. The extent of these delayed effects varies with radiation dose, brain volume irradiated, and age at treatment, and might also be influenced by genetic factors and individual susceptibility. CRT-induced impairment involves axonal damage and disruption of white matter growth, and can affect brain structures implicated in memory function and neurogenesis, such as the hippocampus. In this article, we review the underlying mechanisms and clinical consequences of CRT-induced neurocognitive damage in survivors of paediatric brain tumours. We discuss the recent application of neuroimaging technologies to identify white matter injury following CRT, and highlight new radiation techniques, pharmacological and neurological interventions, as well as rehabilitation programmes that have potential to minimize neurocognitive impairment following CRT.

Key Points

  • Cranial radiation therapy (CRT) for treatment of brain tumours in paediatric patients can cause subsequent neurocognitive impairment, particularly in patients who were very young at the time of irradiation

  • CRT can impair development of white and grey matter, and can inhibit neurogenesis and synaptic plasticity—two processes that are crucial for learning and academic achievement

  • Additional factors, such as the tumour itself, hydrocephalus, chemotherapy and other drugs, can contribute to cognitive impairment in survivors of paediatric brain tumours

  • New strategies to prevent and treat CRT-induced neurocognitive damage, most notably new radiation techniques that spare healthy brain tissue, are increasingly used to avoid this adverse effect of radiotherapy

  • Rehabilitation of paediatric patients treated with CRT is also possible through the child's school environment and cognitive training programmes

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Figure 1: Effect of cranial radiation therapy on IQ in paediatric patients with low-grade glioma.
Figure 2: New approaches to avoid radiation-induced neurotoxicity.
Figure 3: Management of neurotoxicity induced by radiation therapy.

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Authors and Affiliations

  1. Department of Radiation Oncology and Paediatrics, CHU La Timone, Assistance Publique des Hôpitaux de Marseille, 264 Boulevard Jean Moulin, Marseille, 13005, France

    Laetitia Padovani & Xavier Muracciole

  2. Department of Paediatric Haematology and Oncology, CHU La Timone Enfant, Assistance Publique des Hôpitaux de Marseille, 264 Boulevard Jean Moulin, Marseille, 13005, France

    Nicolas André

  3. Departments of Radiation Oncology and Pediatrics, University of Rochester Medical Center, PO Box 647, Rochester, 14642, NY, USA

    Louis S. Constine

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  1. Laetitia Padovani
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  2. Nicolas André
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  3. Louis S. Constine
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  4. Xavier Muracciole
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Contributions

All authors contributed to researching data for the article. L. Padovani, N. André and X. Muracciole made substantial contributions to discussion of the content and writing of the article. All authors contributed to review and/or editing of the manuscript before submission.

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Correspondence to Laetitia Padovani.

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Supplementary information

Supplementary Table 1

Studies of pharmacological strategies to decrease neurotoxicity of radiotherapy (DOC 79 kb)

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Padovani, L., André, N., Constine, L. et al. Neurocognitive function after radiotherapy for paediatric brain tumours. Nat Rev Neurol 8, 578–588 (2012). https://doi.org/10.1038/nrneurol.2012.182

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