Department of Psychology, St Jude Children's Research Hospital, Memphis, TN.
Children's Health Queensland Hospital, South Brisbane, Australia.
J Clin Oncol. 2021 Jul 20;39(21):2350-2358. doi: 10.1200/JCO.20.01687. Epub 2021 May 4.
Infants treated for CNS malignancies experience a significantly poorer response to treatment and are particularly at risk for neuropsychological deficits. The literature is limited and inconsistent regarding cognitive outcomes among this group. We investigated predictors of cognitive outcomes in children treated for brain tumors during infancy as part of a large, prospective, multisite, longitudinal trial.
One hundred thirty-nine infants with a newly diagnosed CNS tumor were treated with chemotherapy, with or without focal proton or photon radiation therapy (RT). Cognitive assessments were conducted at baseline, 6 months, 1 year, and then annually for 5 years. The median length of follow-up was 816 days (26.8 months). Neurocognitive testing included assessment of intellectual functioning (intellectual quotient [IQ]), parent ratings of executive functioning and emotional and behavioral functioning, and socioeconomic status.
At baseline, IQ, parent-reported working memory, and parent-reported adaptive functioning were worse than normative expectations. Baseline cognitive difficulties were associated with younger age at diagnosis and lower socioeconomic status. Linear mixed models did not demonstrate a decline in IQ over time. There were increased parent-reported attention and executive problems over time. Increased concerns were related to supratentorial tumor location and CSF diversion. There were no differences in cognitive outcomes based on treatment exposure (chemotherapy-only chemotherapy with RT and proton photon focal RT).
Even before adjuvant therapy, young children with brain tumors experience cognitive difficulties that can affect quality of life. Changes in cognitive functioning over time were dependent on tumor location and surgical factors rather than adjuvant therapy. These findings may serve to guide treatment planning and indicate targets for cognitive monitoring and intervention.
接受中枢神经系统恶性肿瘤治疗的婴儿对治疗的反应明显较差，尤其存在神经心理缺陷的风险。该领域的文献有限且不一致，无法全面了解这一群体的认知结果。我们针对在婴儿期接受脑肿瘤治疗的儿童开展了一项大型、前瞻性、多中心、纵向试验，调查了认知结果的预测因素。
139 名新诊断为中枢神经系统肿瘤的婴儿接受了化疗，联合或不联合局部质子或光子放射治疗（RT）。在基线、6 个月、1 年进行认知评估，然后每年进行 5 年。中位随访时间为 816 天（26.8 个月）。神经认知测试包括智力功能评估（智商 [IQ]）、父母对执行功能和情绪及行为功能的评估，以及社会经济地位。
在基线时，IQ、父母报告的工作记忆和父母报告的适应功能均低于正常预期。基线时的认知困难与诊断时年龄较小和社会经济地位较低有关。线性混合模型并未显示 IQ 随时间下降。随着时间的推移，父母报告的注意力和执行问题增加。关注度的增加与幕上肿瘤位置和脑脊液分流有关。基于治疗暴露（仅化疗、化疗联合 RT 和质子 RT 光子 RT），认知结果没有差异。
即使在辅助治疗之前，患有脑肿瘤的幼儿就已经存在认知困难，这可能会影响生活质量。认知功能随时间的变化取决于肿瘤位置和手术因素，而不是辅助治疗。这些发现可能有助于指导治疗计划，并为认知监测和干预指明目标。
