Skip to main content
PMC home page
Archives of Disease in Childhood logoLink to Archives of Disease in Childhood
. 1994 Jun;70(6):476–483. doi: 10.1136/adc.70.6.476

Intellectual, educational, and behavioural sequelae after cranial irradiation and chemotherapy.

V Anderson 1, E Smibert 1, H Ekert 1, T Godber 1
PMCID: PMC1029864  PMID: 8048815

Abstract

Cognitive and educational sequelae are inconsistently reported in children treated with cranial irradiation for acute lymphoblastic leukaemia. This study investigated differences in these skills after cranial irradiation, controlling the effects of chemotherapy and psychosocial factors. Three groups were evaluated: 100 children diagnosed with acute lymphoblastic leukaemia and treated with cranial irradiation and chemotherapy; 50 children diagnosed with acute lymphoblastic leukaemia or other cancers and treated with chemotherapy alone; and a healthy control group of 100 children. Children in the clinical groups stopped treatment at least two years before evaluation and had no history of relapse. Children were aged between 7 and 16 at the time of assessment. Evaluation included cognitive, educational, and behavioural measures. Analyses found that children receiving cranial irradiation and chemotherapy performed more poorly than non-irradiated groups on intellectual and educational tests, with verbal and attentional deficits most pronounced. Children receiving chemotherapy alone performed similarly to controls, suggesting such treatment is not associated with adverse neurobehavioural sequelae.

Full text

PDF
476

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson V. Why do intelligent children have learning difficulties? The neuropsychological perspective. J Paediatr Child Health. 1992 Aug;28(4):278–280. doi: 10.1111/j.1440-1754.1992.tb02665.x. [DOI] [PubMed] [Google Scholar]
  2. Ball W. S., Jr, Prenger E. C., Ballard E. T. Neurotoxicity of radio/chemotherapy in children: pathologic and MR correlation. AJNR Am J Neuroradiol. 1992 Mar-Apr;13(2):761–776. [PMC free article] [PubMed] [Google Scholar]
  3. Balsom W. R., Bleyer W. A., Robison L. L., Heyn R. M., Meadows A. T., Sitarz A., Blatt J., Sather H. N., Hammond G. D. Intellectual function in long-term survivors of childhood acute lymphoblastic leukemia: protective effect of pre-irradiation methotrexate? A Childrens Cancer Study Group study. Med Pediatr Oncol. 1991;19(6):486–492. doi: 10.1002/mpo.2950190607. [DOI] [PubMed] [Google Scholar]
  4. Breslau N. Does brain dysfunction increased children's vulnerability to environmental stress? Arch Gen Psychiatry. 1990 Jan;47(1):15–20. doi: 10.1001/archpsyc.1990.01810130017003. [DOI] [PubMed] [Google Scholar]
  5. Brouwers P., Poplack D. Memory and learning sequelae in long-term survivors of acute lymphoblastic leukemia: association with attention deficits. Am J Pediatr Hematol Oncol. 1990 Summer;12(2):174–181. doi: 10.1097/00043426-199022000-00009. [DOI] [PubMed] [Google Scholar]
  6. Brouwers P., Riccardi R., Fedio P., Poplack D. G. Long-term neuropsychologic sequelae of childhood leukemia: correlation with CT brain scan abnormalities. J Pediatr. 1985 May;106(5):723–728. doi: 10.1016/s0022-3476(85)80343-7. [DOI] [PubMed] [Google Scholar]
  7. Brouwers P., Riccardi R., Poplack D., Fedio P. Attentional deficits in long-term survivors of childhood acute lymphoblastic leukemia (ALL). J Clin Neuropsychol. 1984 Aug;6(3):325–336. doi: 10.1080/01688638408401222. [DOI] [PubMed] [Google Scholar]
  8. Brown R. T., Madan-Swain A. Cognitive, neuropsychological, and academic sequelae in children with leukemia. J Learn Disabil. 1993 Feb;26(2):74–90. doi: 10.1177/002221949302600201. [DOI] [PubMed] [Google Scholar]
  9. Cadman D., Boyle M., Szatmari P., Offord D. R. Chronic illness, disability, and mental and social well-being: findings of the Ontario Child Health Study. Pediatrics. 1987 May;79(5):805–813. [PubMed] [Google Scholar]
  10. Copeland D. R., Dowell R. E., Jr, Fletcher J. M., Bordeaux J. D., Sullivan M. P., Jaffe N., Frankel L. S., Ried H. L., Cangir A. Neuropsychological effects of childhood cancer treatment. J Child Neurol. 1988 Jan;3(1):53–62. doi: 10.1177/088307388800300113. [DOI] [PubMed] [Google Scholar]
  11. Copeland D. R., Fletcher J. M., Pfefferbaum-Levine B., Jaffe N., Ried H., Maor M. Neuropsychological sequelae of childhood cancer in long-term survivors. Pediatrics. 1985 Apr;75(4):745–753. [PubMed] [Google Scholar]
  12. Cousens P., Ungerer J. A., Crawford J. A., Stevens M. M. Cognitive effects of childhood leukemia therapy: a case for four specific deficits. J Pediatr Psychol. 1991 Aug;16(4):475–488. doi: 10.1093/jpepsy/16.4.475. [DOI] [PubMed] [Google Scholar]
  13. Dolgin M. J., Katz E. R., McGinty K., Siegel S. E. Anticipatory nausea and vomiting in pediatric cancer patients. Pediatrics. 1985 Mar;75(3):547–552. [PubMed] [Google Scholar]
  14. Eiser C. Cognitive deficits in children treated for leukaemia. Arch Dis Child. 1991 Jan;66(1):164–168. doi: 10.1136/adc.66.1.164. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Eiser C. Effects of chronic illness on intellectual development. A comparison of normal children with those treated for childhood leukaemia and solid tumours. Arch Dis Child. 1980 Oct;55(10):766–770. doi: 10.1136/adc.55.10.766. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Fletcher J. M., Copeland D. R. Neurobehavioral effects of central nervous system prophylactic treatment of cancer in children. J Clin Exp Neuropsychol. 1988 Aug;10(4):495–537. doi: 10.1080/01688638808408255. [DOI] [PubMed] [Google Scholar]
  17. Gamis A. S., Nesbit M. E. Neuropsychologic (cognitive) disabilities in long-term survivors of childhood cancer. Pediatrician. 1991;18(1):11–19. [PubMed] [Google Scholar]
  18. Giralt J., Ortega J. J., Olive T., Verges R., Forio I., Salvador L. Long-term neuropsychologic sequelae of childhood leukemia: comparison of two CNS prophylactic regimens. Int J Radiat Oncol Biol Phys. 1992;24(1):49–53. doi: 10.1016/0360-3016(92)91020-n. [DOI] [PubMed] [Google Scholar]
  19. Greenberg H. S., Kazak A. E., Meadows A. T. Psychologic functioning in 8- to 16-year-old cancer survivors and their parents. J Pediatr. 1989 Mar;114(3):488–493. doi: 10.1016/s0022-3476(89)80581-5. [DOI] [PubMed] [Google Scholar]
  20. Hartlage L. C., Telzrow C. F. The neuropsychological basis of educational intervention. J Learn Disabil. 1983 Nov;16(9):521–528. doi: 10.1177/002221948301600904. [DOI] [PubMed] [Google Scholar]
  21. Howes D., Boller F. Simple reaction time: evidence for focal impairment from lesions of the right hemisphere. Brain. 1975 Jun;98(2):317–332. doi: 10.1093/brain/98.2.317. [DOI] [PubMed] [Google Scholar]
  22. Ivnik R. J., Colligan R. C., Obetz S. W., Smithson W. A. Neuropsychologic performance among children in remission from acute lymphocytic leukemia. J Dev Behav Pediatr. 1981 Jun;2(2):29–34. [PubMed] [Google Scholar]
  23. Kashani J., Hakami N. Depression in children and adolescents with malignancy. Can J Psychiatry. 1982 Oct;27(6):474–477. doi: 10.1177/070674378202700607. [DOI] [PubMed] [Google Scholar]
  24. Lansky S. B., Cairns N. U., Lansky L. L., Cairns G. F., Stephenson L., Garin G. Central nervous system prophylaxis. Studies showing impairment in verbal skills and academic achievement. Am J Pediatr Hematol Oncol. 1984 Summer;6(2):183–190. doi: 10.1097/00043426-198406020-00012. [DOI] [PubMed] [Google Scholar]
  25. Marsden C. D. The mysterious motor function of the basal ganglia: the Robert Wartenberg Lecture. Neurology. 1982 May;32(5):514–539. doi: 10.1212/wnl.32.5.514. [DOI] [PubMed] [Google Scholar]
  26. Metter E. J., Riege W. H., Hanson W. R., Jackson C. A., Kempler D., van Lancker D. Subcortical structures in aphasia. An analysis based on (F-18)-fluorodeoxyglucose, positron emission tomography, and computed tomography. Arch Neurol. 1988 Nov;45(11):1229–1234. doi: 10.1001/archneur.1988.00520350067018. [DOI] [PubMed] [Google Scholar]
  27. Mulhern R. K., Fairclough D., Ochs J. A prospective comparison of neuropsychologic performance of children surviving leukemia who received 18-Gy, 24-Gy, or no cranial irradiation. J Clin Oncol. 1991 Aug;9(8):1348–1356. doi: 10.1200/JCO.1991.9.8.1348. [DOI] [PubMed] [Google Scholar]
  28. Mulhern R. K., Wasserman A. L., Fairclough D., Ochs J. Memory function in disease-free survivors of childhood acute lymphocytic leukemia given CNS prophylaxis with or without 1,800 cGy cranial irradiation. J Clin Oncol. 1988 Feb;6(2):315–320. doi: 10.1200/JCO.1988.6.2.315. [DOI] [PubMed] [Google Scholar]
  29. Noll R. B., Bukowski W. M., Rogosch F. A., LeRoy S., Kulkarni R. Social interactions between children with cancer and their peers: teacher ratings. J Pediatr Psychol. 1990 Feb;15(1):43–56. doi: 10.1093/jpepsy/15.1.43. [DOI] [PubMed] [Google Scholar]
  30. Ochs J. J. Neurotoxicity due to central nervous system therapy for childhood leukemia. Am J Pediatr Hematol Oncol. 1989 Spring;11(1):93–105. doi: 10.1097/00043426-198921000-00019. [DOI] [PubMed] [Google Scholar]
  31. Peckham V. C. Educational deficits in survivors of childhood cancer. Pediatrician. 1991;18(1):25–31. [PubMed] [Google Scholar]
  32. Price R. A., Jamieson P. A. The central nervous system in childhood leukemia. II. Subacute leukoencephalopathy. Cancer. 1975 Feb;35(2):306–318. doi: 10.1002/1097-0142(197502)35:2<306::aid-cncr2820350203>3.0.co;2-j. [DOI] [PubMed] [Google Scholar]
  33. Päkkö E., Vainionpä L., Lanning M., Laitinen J., Pyhtinen J. White matter changes in children treated for acute lymphoblastic leukemia. Cancer. 1992 Dec 1;70(11):2728–2733. doi: 10.1002/1097-0142(19921201)70:11<2728::aid-cncr2820701126>3.0.co;2-7. [DOI] [PubMed] [Google Scholar]
  34. Rodgers J., Britton P. G., Morris R. G., Kernahan J., Craft A. W. Memory after treatment for acute lymphoblastic leukaemia. Arch Dis Child. 1992 Mar;67(3):266–268. doi: 10.1136/adc.67.3.266. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Rowland J. H., Glidewell O. J., Sibley R. F., Holland J. C., Tull R., Berman A., Brecher M. L., Harris M., Glicksman A. S., Forman E. Effects of different forms of central nervous system prophylaxis on neuropsychologic function in childhood leukemia. J Clin Oncol. 1984 Dec;2(12):1327–1335. doi: 10.1200/JCO.1984.2.12.1327. [DOI] [PubMed] [Google Scholar]
  36. Sawyer M. G., Toogood I., Rice M., Haskell C., Baghurst P. School performance and psychological adjustment of children treated for leukemia. A long-term follow-up. Am J Pediatr Hematol Oncol. 1989 Summer;11(2):146–152. [PubMed] [Google Scholar]
  37. Soni S. S., Marten G. W., Pitner S. E., Duenas D. A., Powazek M. Effects of central-nervous-system irradiation on neuropsychologic functioning of children with acute lymphocytic leukemia. N Engl J Med. 1975 Jul 17;293(3):113–118. doi: 10.1056/NEJM197507172930303. [DOI] [PubMed] [Google Scholar]
  38. Spreen O. The relationship between learning disability, emotional disorders, and neuropsychology; some results and observations. J Clin Exp Neuropsychol. 1989 Jan;11(1):117–140. doi: 10.1080/01688638908400880. [DOI] [PubMed] [Google Scholar]
  39. Stehbens J. A., Kaleita T. A., Noll R. B., MacLean W. E., Jr, O'Brien R. T., Waskerwitz M. J., Hammond G. D. CNS prophylaxis of childhood leukemia: what are the long-term neurological, neuropsychological, and behavioral effects? Neuropsychol Rev. 1991 Jun;2(2):147–177. doi: 10.1007/BF01109052. [DOI] [PubMed] [Google Scholar]
  40. Taylor H. G., Albo V. C., Phebus C. K., Sachs B. R., Bierl P. G. Postirradiation treatment outcomes for children with acute lymphocytic leukemia: clarification of risks. J Pediatr Psychol. 1987 Sep;12(3):395–411. doi: 10.1093/jpepsy/12.3.395. [DOI] [PubMed] [Google Scholar]
  41. Tsuruda J. S., Kortman K. E., Bradley W. G., Wheeler D. C., Van Dalsem W., Bradley T. P. Radiation effects on cerebral white matter: MR evaluation. AJR Am J Roentgenol. 1987 Jul;149(1):165–171. doi: 10.2214/ajr.149.1.165. [DOI] [PubMed] [Google Scholar]
  42. Valk J., van der Knaap M. S. Toxic encephalopathy. AJNR Am J Neuroradiol. 1992 Mar-Apr;13(2):747–760. [PMC free article] [PubMed] [Google Scholar]
  43. Wallesch C. W., Kornhuber H. H., Brunner R. J., Kunz T., Hollerbach B., Suger G. Lesions of the basal ganglia, thalamus, and deep white matter: differential effects on language functions. Brain Lang. 1983 Nov;20(2):286–304. doi: 10.1016/0093-934x(83)90046-9. [DOI] [PubMed] [Google Scholar]

Articles from Archives of Disease in Childhood are provided here courtesy of BMJ Publishing Group

RESOURCES