Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts; Harvard Medical School, Harvard University, Boston, Massachusetts.
Int J Radiat Oncol Biol Phys. 2018 Oct 1;102(2):391-398. doi: 10.1016/j.ijrobp.2018.05.069. Epub 2018 Jun 6.
Radiation therapy is integral in treatment of pediatric brain tumors, but it is associated with negative long-term sequelae. Proton beam radiation therapy (PRT), which enables better focusing of radiation on tumors, may entail fewer sequelae. This prospective study examined cognitive and adaptive functioning in children and young adults treated with PRT.
A total of 155 patients were assessed using age-appropriate measures for cognitive and adaptive functioning at start of or during PRT (baseline) and at follow-up. Mean age at baseline was 8.9 years; mean follow-up interval was 3.6 years. Diagnoses included medulloblastoma, craniopharyngioma, ependymoma, glial tumors, germ cell tumors, and others. The sample was divided by age at baseline (<6 years [N = 57, or 37%] and ≥6 years [N = 98, or 63%]) and by PRT field (craniospinal irradiation [CSI; 39%] and focal irradiation [61%]).
Scores for mean intelligence quotient (IQ) and adaptive functioning skills were in the average range at baseline and follow-up. Overall, mean IQ scores declined from 105.4 to 102.5 (P = .005); however, only the younger CSI group showed significant decline. Patients receiving CSI, regardless of age, appeared particularly vulnerable in IQ, processing speed, and working memory. Adaptive skills were stable across the 4 age-by-treatment field groups.
At a mean of 3.6 years after PRT, IQ declined slightly for the group, largely because of significant IQ decline in younger patients treated with CSI. No significant change was seen in patients <6 years treated with focal PRT or in older patients. Adaptive skills remained stable across age and treatment type.
放射治疗是小儿脑肿瘤治疗的重要组成部分，但它会带来长期的负面后果。质子束放射治疗（PRT）能够更好地将辐射聚焦在肿瘤上，可能会减少这些后遗症。本前瞻性研究调查了接受 PRT 治疗的儿童和青少年的认知和适应功能。
共有 155 名患者在开始或进行 PRT 时（基线）以及随访时接受了适合年龄的认知和适应功能评估。基线时的平均年龄为 8.9 岁；平均随访间隔为 3.6 年。诊断包括髓母细胞瘤、颅咽管瘤、室管膜瘤、神经胶质瘤、生殖细胞瘤和其他肿瘤。根据基线时的年龄（<6 岁[57 例，37%]和≥6 岁[98 例，63%]）和 PRT 照射野（全脑全脊髓照射[39%]和局灶照射[61%]）将样本分为两组。
基线和随访时的平均智商（IQ）和适应功能评分均处于平均水平。总体而言，平均 IQ 评分从 105.4 降至 102.5（P=0.005）；然而，只有较小的 CSI 组显示出显著下降。接受 CSI 的患者，无论年龄大小，在 IQ、处理速度和工作记忆方面似乎都特别脆弱。适应技能在 4 个年龄-治疗组之间保持稳定。
在 PRT 后平均 3.6 年，该组的 IQ 略有下降，主要是因为接受 CSI 治疗的较小年龄患者的 IQ 显著下降。接受局灶性 PRT 治疗的<6 岁患者或年龄较大的患者未见 IQ 显著变化。适应技能在年龄和治疗类型方面保持稳定。
