Qol-30. Neuropsychological Functioning After Whole Ventricular or Craniospinal Proton Radiation for Pediatric Intracranial Germ Cell Tumors

BACKGROUND In Western countries, intracranial germ cell tumors (ICGT) represent 3-5% of central nervous system tumors, with peak incidence in the second decade of life. Compared to those receiving photon radiation therapy, pediatric patients receiving proton radiation therapy demonstrate stronger neurocognitive outcomes, particularly in verbal and visual reasoning. Ongoing treatment advances aim to reduce morbidity, such as neurocognitive late effects. This study characterizes memory functioning for patients with intracranial germinoma treated with either whole ventricular (WV) or craniospinal (CSI) proton radiation therapy. METHODS 29 patients received proton radiation therapy (17 WV, 12 CSI) for an ICGT (20 germinoma, 8 NGGCT, 1 mixed GCT; 3 disseminated at diagnosis). Age at diagnosis was 5-21 years (M=14.14; SD=3.91) with age at neuropsychological evaluation 8-25 years (M=17.66, SD=4.11). Evaluations occurred 0.71-7.85 years after diagnosis (M=3.52; SD=2.02). Patients (82.8% male, 65.5% white, 44.8% Very High Childhood Opportunity Index [COI]) had multiple additional interventions (surgeries, chemotherapy) prior to neuropsychological evaluation. RESULTS Patients in the WV group did not differ from patients in the CSI group on sex, COI, race, or ethnicity. Mean performance was stronger in the WV group than the CSI group for Full Scale IQ (FSIQ; t(27)=2.50, p=.019, Cohen’s d =0.94), Verbal Reasoning (VCI; t(24)=2.52, p=.019, d=1.0), Visual Memory (WRAML-2 Picture Memory Recognition; t(14)=2.51, p=.025, d=1.26), and Verbal Memory [(WRAML-2 Story Memory Delay, t(15.32)=2.82, p=.013, d=1.25); (WRAML-2 Story Memory Recognition, t(20)=2.34, p=.03, d=1.0)], all with large effect sizes. CONCLUSIONS Within this small ICGT sample with various medical treatments and comorbidities, demographic factors did not differ between groups, and WV proton radiation therapy appears to have less negative impact on aspects of reasoning and memory abilities compared to CSI proton radiation therapy.