Assessment of Clinical and Neurological Alterations Before Radiation Therapy in Children With Malignant Brain Tumours

Aim: Young patients with a brain tumour (BT) show neurocognitive alterations as both consequences of the tumour and of the treatments received. In this paper we present the basal analysis of a patient's series, correlating tumour localisation, symptoms, neurological/endocrinological impairments, surgery/ies +/- chemotherapy, and cognitive assessments at the time of enrolment before focal-radiotherapy (RT). Methods: Sixty-six children eligible for focal RT underwent a neurocognitive assessment. The demographic, pathological and clinical variables with MRI morphological scans, where different kinds of damage scores were defined, were analysed. Results: The patientssmedian age was 8 years; the most frequent tumour was ependymoma (41%), and supratentorial (71%) was the prevalent site. All but 2 children (with germ cell tumours), had received surgery and 32 chemotherapy courses before irradiation. Ad-hoc scores for neurological deficits, endocrine alterations and structural abnormalities were created and applied. Patients with infratentorial tumours locations showed the highest score of neurological damage while endocrine alterations were more serious in patients with craniopharyngioma and germ cell tumours of the sellar region and ventricular system. The median number of damaged areas was equal to 2 for each child. Neurological deficit scores were not associated with hydrocephalus and surgery/ies received, unlike endocrine deficits. Tumour site, length of symptoms and endocrine alterations were found to be associated with cognitive impairment. Conclusion: The pre-radiation evaluations highlighted that damages develop already prior to focal-RT. Specific scores may quantify damages that are generated by multiple factors that need to be considered over time after irradiation.