• Iska Moxon-Emre, Eric Bouffet, Michael D Taylor, Normand Laperriere, Nadia Scantlebury, Nicole Law, Brenda J Spiegler, David Malkin, Laura Janzen, and Donald Mabbott.
• Iska Moxon-Emre, Eric Bouffet, Michael D. Taylor, Nadia Scantlebury, Nicole Law, Brenda J. Spiegler, David Malkin, Laura Janzen, and Donald Mabbott, Hospital for Sick Children; Iska Moxon-Emre, Michael D. Taylor, Normand Laperriere, Brenda J. Spiegler, David Malkin, and Laura Janzen, University of Toronto; and Normand Laperriere, Ontario Cancer Institute, Princess Margaret Hospital, Toronto, Ontario, Canada.
• J. Clin. Oncol. 2014 Jun 10; 32 (17): 1760-8.

PurposeTo examine the impact of radiation (ie, craniospinal irradiation [CSR] dose and boost volume) and complications (ie, hydrocephalus and other neurologic complications, including mutism) on patterns of change in intellectual functioning in medulloblastoma survivors.Patients And MethodsWe conducted a retrospective review of 113 patients treated for medulloblastoma between 1983 and 2011 who were seen for neuropsychological assessment, including longitudinal follow-up of intellectual function. Patients were treated with either standard-dose CSR with a posterior fossa (PF) boost (n=51), standard-dose CSR plus tumor bed (TB) boost (n=9), reduced-dose CSR plus PF boost (n=28), or reduced-dose CSR plus TB boost (n=23), with or without chemotherapy. A subset of patients developed hydrocephalus that required cerebrospinal fluid (CSF) diversion (n=54) and/or other neurologic complications (n=40), more than half of which were postoperative mutism (n=25). Growth curve analysis was used to determine stability or change in intelligence scores over time.ResultsPatients treated with reduced-dose CSR plus TB boost showed stable intellectual trajectories, whereas patients treated with higher doses and larger boost volumes experienced intellectual declines. Presence of complications was associated with worse intellectual outcome; however, hydrocephalus requiring CSF diversion and mutism differed in their pattern of decline.ConclusionThese results improve our understanding of factors that impair intellectual outcome in patients treated for medulloblastoma. Lower doses of CSR and smaller boost volumes seem to mitigate intellectual decline. Our findings validate the use of TB boost and suggest PF boost should be reconsidered.© 2014 by American Society of Clinical Oncology.

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