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PNET4 欧洲随机对照试验中标准风险髓母细胞瘤接受超分割与标准放疗和维持化疗治疗的儿童的神经心理学结局。

Neuropsychological Outcome of Children Treated for Standard Risk Medulloblastoma in the PNET4 European Randomized Controlled Trial of Hyperfractionated Versus Standard Radiation Therapy and Maintenance Chemotherapy.

机构信息

National Institute of Health and Medical Research, INSERM U1178, Paris, France.

University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Int J Radiat Oncol Biol Phys. 2015 Aug 1;92(5):978-985. doi: 10.1016/j.ijrobp.2015.04.023. Epub 2015 Apr 17.

Abstract

PURPOSE

In the European HIT-SIOP PNET4 randomized controlled trial, children with standard risk medulloblastoma were allocated to hyperfractionated radiation therapy (HFRT arm, including a partially focused boost) or standard radiation therapy (STRT arm), followed, in both arms, by maintenance chemotherapy. Event-free survival was similar in both arms. Previous work showed that the HFRT arm was associated with worse growth and better questionnaire-based executive function, especially in children <8 years of age at diagnosis. Therefore, the aim of this study was to compare performance-based cognitive outcomes between treatment arms.

METHODS AND MATERIALS

Neuropsychological data were collected prospectively in 137 patients. Using the Wechsler Intelligence Scales, Kaufman Assessment Battery for Children, and Raven's Progressive Matrices, we estimated full-scale intelligence quotient (FSIQ) and, when available, verbal IQ (VIQ), performance IQ (PIQ), working memory index (WMI), and processing speed index (PSI).

RESULTS

Among the 137 participants (HFRT arm n=71, STRT arm n=66, 63.5% males), mean (±SD) ages at diagnosis and assessment respectively were 9.3 (±3.2) years of age (40.8% < 8 years of age at diagnosis) and 14.6 (±4.3) years of age. Mean (±SD) FSIQ was 88 (±19), and mean intergroup difference was 3.88 (95% confidence interval: -2.66 to 10.42, P=.24). No significant differences were found in children >8 years of age at diagnosis. In children <8 years of age at diagnosis, a marginally significant trend toward higher VIQ was found in those treated in the HFRT arm; a similar trend was found for PSI but not for PIQ, WMI, or FSIQ (mean intergroup differences were: 12.02 for VIQ [95% CI: 2.37-21.67; P=.02]; 3.77 for PIQ [95% CI: -5.19 to 12.74; P>.10]; 5.20 for WMI [95% CI: -2.07 to 12.47; P>.10]; 10.90 for PSI [95% CI: -1.54 to 23.36; P=.08]; and 5.28 for FSIQ [95% CI: -4.23 to 14.79; P>.10]).

CONCLUSIONS

HFRT was associated with marginally higher VIQ in children <8 years of age at diagnosis, consistent with a previous report using questionnaire-based data. However, overall cognitive ability was not significantly different.

摘要

目的

在欧洲 HIT-SIOP PNET4 随机对照试验中,标准风险髓母细胞瘤患儿被分配到超分割放疗(HFRT 组,包括部分聚焦增强)或标准放疗(STRT 组),两组患儿均接受维持化疗。两组的无事件生存率相似。之前的研究表明,HFRT 组与较差的生长和更好的基于问卷的执行功能有关,特别是在诊断时年龄<8 岁的患儿中。因此,本研究旨在比较治疗组之间基于表现的认知结果。

方法和材料

前瞻性收集了 137 名患者的神经心理学数据。我们使用韦氏智力量表、考夫曼儿童评估量表和瑞文渐进矩阵,估计了全量表智商(FSIQ),并在可用时估计了言语智商(VIQ)、操作智商(PIQ)、工作记忆指数(WMI)和处理速度指数(PSI)。

结果

在 137 名参与者(HFRT 组 n=71,STRT 组 n=66,63.5%为男性)中,诊断时和评估时的平均(±SD)年龄分别为 9.3(±3.2)岁(40.8%<8 岁)和 14.6(±4.3)岁。平均(±SD)FSIQ 为 88(±19),组间平均差异为 3.88(95%置信区间:-2.66 至 10.42,P=.24)。在诊断时年龄>8 岁的儿童中,未发现显著差异。在诊断时年龄<8 岁的儿童中,HFRT 组的 VIQ 有较高的趋势,但无统计学意义;PSI 也有类似的趋势,但 PIQ、WMI 或 FSIQ 则没有(组间平均差异分别为:VIQ 为 12.02(95% CI:2.37-21.67;P=.02);PIQ 为 3.77(95% CI:-5.19 至 12.74;P>.10);WMI 为 5.20(95% CI:-2.07 至 12.47;P>.10);PSI 为 10.90(95% CI:-1.54 至 23.36;P=.08);FSIQ 为 5.28(95% CI:-4.23 至 14.79;P>.10))。

结论

HFRT 与诊断时年龄<8 岁的患儿的 VIQ 略有升高有关,这与之前使用问卷数据的报告一致。然而,整体认知能力并无显著差异。

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