OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Helmholtz-Zentrum Dresden - Rossendorf, Institute of Radiooncology - OncoRay, Dresden, Germany; German Cancer Consortium (DKTK), Partner Site Dresden, and German Cancer Research Center (DKFZ), Heidelberg, Germany.
OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany; Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
Radiother Oncol. 2020 Feb;143:108-116. doi: 10.1016/j.radonc.2019.12.024. Epub 2020 Feb 8.
Neurocognitive function of adult patients with brain tumours may deteriorate after radiotherapy. Proton beam therapy (PBT) reduces the volume of irradiated healthy brain tissue and could potentially preserve neurocognition and quality of life (QoL). As present data are still limited, the impact of clinical factors and dosimetric parameters on neurocognitive function and QoL during recurrence-free follow-up after PBT is investigated.
The current study includes 62 brain tumour patients treated with PBT between 2015 and 2017. Neurocognition and QoL were assessed at baseline and every 3 months after PBT using the Montreal Cognitive Assessment (MoCA) test together with EORTC-QLQ-C30 and BN20 questionnaires, respectively. Objective and self-reported measures of neurocognitive functions were correlated. During two years of follow-up, the impact of clinical co-factors as well as dosimetric parameters of several brain structures were analysed using a mixed-model approach.
At baseline, mean MoCA total score was 24.8/30 and self-reported cognitive function was 68.9/100. Both remained stable over time. Patients with impaired neurocognition on the MoCA test reported significantly lower global health status, cognitive, physical and role function as well as more fatigue, pain, headache and communication deficits compared to normal performing patients. For most follow-up time points, the majority of MoCA subitems correlated significantly to QoL items regarding neurocognition. Slight deterioration of the MoCA score was associated with tumours located in the left hemisphere and with an increase in relative volume of the anterior cerebellum that received doses of 30-40 Gy(RBE).
Self-reported and objectively measured neurocognition and most other QoL domains remained largely stable over time during recurrence-free follow-up for brain tumour patients treated with PBT. The association between reduced cognitive function and irradiated volume of the anterior cerebellum requires validation in larger studies and comparison to patients treated with photon therapy.
成人脑瘤患者在接受放射治疗后，其神经认知功能可能会恶化。质子束治疗（PBT）可减少受照射的健康脑组织的体积，从而有可能保持神经认知功能和生活质量（QoL）。由于目前的数据仍然有限，因此研究了 PBT 后无复发生存随访期间临床因素和剂量学参数对神经认知功能和 QoL 的影响。
本研究纳入了 2015 年至 2017 年间接受 PBT 治疗的 62 例脑瘤患者。使用蒙特利尔认知评估（MoCA）测试和 EORTC-QLQ-C30 和 BN20 问卷，分别在 PBT 前和 PBT 后每 3 个月评估神经认知功能和 QoL。将客观和自我报告的神经认知功能测量结果进行了相关性分析。在两年的随访期间，使用混合模型方法分析了几个脑结构的临床合并因素以及剂量学参数的影响。
在基线时，MoCA 总分的平均值为 24.8/30，自我报告的认知功能为 68.9/100。两者在随访期间均保持稳定。在 MoCA 测试中表现出神经认知障碍的患者报告其总体健康状况、认知、身体和角色功能明显降低，并且疲劳、疼痛、头痛和沟通障碍更多。在大多数随访时间点，MoCA 子项与 QoL 项中的神经认知项显著相关。MoCA 评分的轻微恶化与位于左半球的肿瘤以及接受 30-40Gy（RBE）剂量的前小脑相对体积增加有关。
在接受 PBT 治疗的脑瘤患者无复发生存随访期间，自我报告和客观测量的神经认知功能以及大多数其他 QoL 领域在随访期间基本保持稳定。认知功能下降与前小脑受照射体积之间的关联需要在更大的研究中进行验证，并与接受光子治疗的患者进行比较。
