Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Cancer. 2018 May 15;124(10):2238-2245. doi: 10.1002/cncr.31143. Epub 2018 Mar 2.
Radiotherapy (RT) in the pediatric brain tumor population causes late neurocognitive effects. In the current study, the authors investigated associations between clinical and dosimetric risk factors and memory outcomes in a cohort of patients treated with proton radiotherapy (PRT).
A total of 70 patients (median age at PRT, 12.1 years [range, 5.0-22.5 years]) who were treated with PRT were identified with baseline and follow-up evaluations of visual and verbal memory (Children's Memory Scale and the third edition of the Wechsler Memory Scale). Whole-brain as well as bilateral hippocampal and temporal lobe contours were delineated for the calculation of dosimetric indices. Multivariate analyses were performed to assess associations of score changes over time with clinical factors and dosimetric indices.
The median neurocognitive follow-up was 3.0 years (range, 1.1-11.4 years). For the entire cohort, delayed and immediate verbal memory scaled scores demonstrated small declines. The mean decline for delayed verbal memory scores was 0.6 (P = .01), and that for immediate verbal memory scores was 0.5 (P = .06). Immediate and delayed visual memory scores were not found to change significantly (+0.1 and -0.3, respectively; P>.30). A higher left hippocampal V (percentage of the volume of a particular anatomical region receiving at least a 20 gray equivalent) was correlated with a score decline in all 4 measures. Female sex was found to be predictive of lower delayed verbal memory follow-up scores (P = .035).
Only delayed verbal memory scores were found to have declined statistically significantly at follow-up after PRT, reflecting some weakness in verbal memory retrieval. Given a correlation of left hippocampal dosimetry and memory outcomes after PRT, left hippocampal-sparing PRT plans may assist patients with pediatric brain tumors in preserving memory-retrieval abilities. Cancer 2018;124:2238-45. © 2018 American Cancer Society.
放射治疗（RT）在儿科脑肿瘤患者中会引起迟发性神经认知效应。在本研究中，作者研究了质子放射治疗（PRT）治疗的患者队列中临床和剂量学危险因素与记忆结果之间的关联。
共确定了 70 名患者（PRT 时的中位年龄为 12.1 岁[范围，5.0-22.5 岁]），他们接受了视觉和语言记忆的基线和随访评估（儿童记忆量表和韦氏记忆量表第三版）。勾画全脑以及双侧海马和颞叶轮廓，以计算剂量学指标。进行多变量分析以评估随时间变化的评分变化与临床因素和剂量学指标的关联。
中位神经认知随访时间为 3.0 年（范围，1.1-11.4 年）。对于整个队列，延迟和即时言语记忆量表评分显示出较小的下降。延迟言语记忆评分的平均下降为 0.6（P=.01），即时言语记忆评分的平均下降为 0.5（P=.06）。即时和延迟视觉记忆评分均无明显变化（分别为+0.1 和-0.3；P>.30）。左海马 V 更高（特定解剖区域的体积百分比，接受至少 20 戈瑞当量）与所有 4 项测量的评分下降相关。发现女性的性别与较低的延迟言语记忆随访评分相关（P=.035）。
在 PRT 后随访时，只有延迟言语记忆评分在统计学上显示出下降，反映出言语记忆检索能力的一些下降。鉴于 PRT 后左海马剂量学与记忆结果的相关性，左海马保护 PRT 计划可能有助于患有脑肿瘤的儿科患者保留记忆检索能力。癌症 2018；124:2238-45。©2018 美国癌症协会。
