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Front Oncol. 2017 Aug 18;7:166. doi: 10.3389/fonc.2017.00166. eCollection 2017.

Relationships between Regional Radiation Doses and Cognitive Decline in Children Treated with Cranio-Spinal Irradiation for Posterior Fossa Tumors.

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INSERM U1129, CEA, Paris Descartes University, Paris, France.
UNIACT, Institut Joliot, DRF, Neurospin, CEA, Paris Saclay University, Gif-sur-Yvette, France.
Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif, France.
Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France.
INSERM, U1030, Villejuif, France.
Paris Sud University, Paris-Saclay University, Villejuif, France.
Gustave Roussy, Paris-Saclay University, Department of Medical Physics, Villejuif, France.
INSERM U992 Unicog CEA, Neurospin, Paris Descartes University, Paris, France.
Institut Joliot, Neurospin, CEA, Paris-Saclay University, Gif-sur-Yvette, France.
CSI Department for Children with Acquired Brain Injury, Hopitaux de Saint Maurice, Saint-Maurice, France.
Paris Sud University, Orsay, France.


Pediatric posterior fossa tumor (PFT) survivors who have been treated with cranial radiation therapy often suffer from cognitive impairments that might relate to IQ decline. Radiotherapy (RT) distinctly affects brain regions involved in different cognitive functions. However, the relative contribution of regional irradiation to the different cognitive impairments still remains unclear. We investigated the relationships between the changes in different cognitive scores and radiation dose distribution in 30 children treated for a PFT. Our exploratory analysis was based on a principal component analysis (PCA) and an ordinary least square regression approach. The use of a PCA was an innovative way to cluster correlated irradiated regions due to similar radiation therapy protocols across patients. Our results suggest an association between working memory decline and a high dose (equivalent uniform dose, EUD) delivered to the orbitofrontal regions, whereas the decline of processing speed seemed more related to EUD in the temporal lobes and posterior fossa. To identify regional effects of RT on cognitive functions may help to propose a rehabilitation program adapted to the risk of cognitive impairment.


cognitive impairments; pediatric; posterior fossa; radiation effects; radiotherapy

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