Department of Radiation Oncology, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Neuro Oncol. 2019 Jul 11;21(7):934-943. doi: 10.1093/neuonc/noz070.
Survivors of pediatric brain tumors are at risk for impaired development in multiple neuropsychological domains. The purpose of this study was to compare neuropsychological outcomes of pediatric brain tumor patients who underwent X-ray radiotherapy (XRT) versus proton radiotherapy (PRT).
Pediatric patients who underwent either XRT or PRT and received posttreatment age-appropriate neuropsychological evaluation-including measures of intelligence (IQ), attention, memory, visuographic skills, academic skills, and parent-reported adaptive functioning-were identified. Multivariate analyses were performed to assess differences in neuropsychological outcomes and included tests for interaction between treatment cohort and follow-up time.
Between 1998 and 2017, 125 patients with tumors located in the supratentorial (17.6%), midline (28.8%), or posterior fossa (53.6%) compartments received radiation and had posttreatment neuropsychological evaluation. Median age at treatment was 7.4 years. The PRT patient cohort had higher estimated SES and shorter median time from radiotherapy completion to last neuropsychological evaluation (6.7 vs 2.6 y, P < 0.001). On multivariable analysis, PRT was associated with higher full-scale IQ (β = 10.6, P = 0.048) and processing speed (β = 14.4, P = 0.007) relative to XRT, with trend toward higher verbal IQ (β = 9.9, P = 0.06) and general adaptive functioning (β = 11.4, P = 0.07). Planned sensitivity analyses truncating follow-up interval in the XRT cohort re-demonstrated higher verbal IQ (P = 0.01) and IQ (P = 0.04) following PRT, with trend toward improved processing speed (P = 0.09).
PRT is associated with favorable outcomes for intelligence and processing speed. Combined with other strategies for treatment de-intensification, PRT may further reduce neuropsychological morbidity of brain tumor treatment.
儿科脑肿瘤幸存者存在多个神经心理学领域发育受损的风险。本研究的目的是比较接受 X 射线放疗（XRT）与质子放疗（PRT）的儿科脑肿瘤患者的神经心理学结果。
确定了接受 XRT 或 PRT 治疗并接受治疗后适合年龄的神经心理学评估的儿科患者，包括智力（IQ）、注意力、记忆、视觉图形技能、学业技能和家长报告的适应功能的测量。进行了多变量分析以评估神经心理学结果的差异，包括治疗队列和随访时间之间的交互作用检验。
在 1998 年至 2017 年期间，有 125 名肿瘤位于幕上（17.6%）、中线（28.8%）或后颅窝（53.6%）的患者接受了放疗，并在治疗后进行了神经心理学评估。治疗时的中位年龄为 7.4 岁。PRT 患者队列的 SES 估计值较高，且从放疗完成到最后一次神经心理学评估的中位时间较短（6.7 岁比 2.6 岁，P<0.001）。多变量分析显示，与 XRT 相比，PRT 与更高的全量表智商（β=10.6，P=0.048）和处理速度（β=14.4，P=0.007）相关，且言语智商（β=9.9，P=0.06）和一般适应功能（β=11.4，P=0.07）有升高趋势。计划的敏感性分析截断 XRT 队列的随访间隔，再次显示 PRT 后言语智商（P=0.01）和智商（P=0.04）更高，处理速度呈升高趋势（P=0.09）。
PRT 与智力和处理速度的良好结果相关。与其他治疗减毒策略相结合，PRT 可能进一步降低脑肿瘤治疗的神经认知发病率。
