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Cognitive Predictors of Social Adjustment in Pediatric Brain Tumor Survivors Treated with Photon versus Proton Radiation Therapy
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  • Emily Warren,
  • Kimberly Raghubar,
  • Paul Cirino,
  • Amanda Child,
  • David Grosshans,
  • Arnold Paulino,
  • M. Okcu,
  • Charles Minard,
  • Doug Ris,
  • Anita Mahajan,
  • Andres Viana,
  • Murali Chintagumpala,
  • Lisa Kahalley
Emily Warren
Baylor College of Medicine

Corresponding Author:emily.hustonw@gmail.com

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Kimberly Raghubar
Baylor College of Medicine
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Paul Cirino
University of Houston
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Amanda Child
Kennedy Krieger Institute
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David Grosshans
The University of Texas MD Anderson Cancer Center
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Arnold Paulino
University of Texas MD Anderson Cancer Center
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M. Okcu
Baylor College of Medicine Department of Pediatrics
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Charles Minard
Baylor College of Medicine
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Doug Ris
Texas Children's Hospital
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Anita Mahajan
Mayo Clinic
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Andres Viana
University of Houston
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Murali Chintagumpala
Texas Children's Hospital
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Lisa Kahalley
Texas Children's Hospital
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Abstract

Background: Pediatric brain tumor survivors are at risk for poor social outcomes. It remains unknown whether cognitive sparing with proton radiotherapy (PRT) supports better social outcomes relative to photon radiotherapy (XRT). We hypothesized that survivors treated with PRT would outperform those treated with XRT on measures of cognitive and social outcomes. Further, we hypothesized that cognitive performance would predict survivor social outcomes. Procedure: Survivors who underwent PRT (n=38) or XRT (n=20) participated in a neurocognitive evaluation >1 year post-radiotherapy. Group differences in cognitive and social functioning were assessed using ANCOVA. Regression analyses examined predictors of peer relations and social skills. Results: Age at evaluation, radiation dose, tumor diameter, and sex did not differ between groups (all p>0.05). However, XRT participants were younger at diagnosis (XRT M=5.0 years, PRT M=7.6 years) and further out from radiotherapy (XRT M=8.7 years, PRT M=4.6 years). The XRT group performed worse than the PRT group on measures of processing speed (p=0.01) and verbal memory (p<0.01); however, social outcomes did not differ by radiation type. The proportion of survivors with impairment in peer relations and social skills exceeded expectation (2(1)=38.67, p<0.001; 2(1)=5.63, p<0.05), and verbal memory approached significance as a unique predictor of peer relations (t=-2.01, p=0.05). Total tumor RT dose significantly predicted social skills (t=-2.23, p<0.05). Conclusions: Regardless of radiation modality, survivors are at risk for social challenges, with one-quarter being socially excluded or undervalued. Deficits in verbal memory may place survivors at particular risk. Results support monitoring of cognitive and social functioning throughout survivorship.
11 Aug 2021Submitted to Pediatric Blood & Cancer
11 Aug 2021Submission Checks Completed
11 Aug 2021Assigned to Editor
15 Aug 2021Reviewer(s) Assigned
06 Sep 2021Review(s) Completed, Editorial Evaluation Pending
08 Sep 2021Editorial Decision: Revise Major
21 Dec 2021Submission Checks Completed
21 Dec 2021Assigned to Editor
21 Dec 20211st Revision Received
17 Jan 2022Reviewer(s) Assigned
15 Feb 2022Review(s) Completed, Editorial Evaluation Pending
15 Feb 2022Editorial Decision: Accept
Jun 2022Published in Pediatric Blood & Cancer volume 69 issue 6. 10.1002/pbc.29645