Weusthof Katharina, Lüttich Peggy, Regnery Sebastian, König Laila, Bernhardt Denise, Witt Olaf, Herfarth Klaus, Unterberg Andreas, Jungk Christine, Farnia Benjamin, Combs Stephanie E, Debus Jürgen, Rieken Stefan, Harrabi Semi, Adeberg Sebastian
Department of Radiation Oncology, Heidelberg University Hospital, 69120 Heidelberg, Germany.
Department of Radiation Oncology, Heidelberg Institute of Radiation Oncology (HIRO), 69120 Heidelberg, Germany.
Cancers (Basel). 2021 Jul 15;13(14):3538. doi: 10.3390/cancers13143538.
Advanced radiation techniques can reduce the severity of neurocognitive sequelae in young brain tumor patients. In the present analysis, we sought to compare neurocognitive outcomes after proton irradiation with patients who underwent photon radiotherapy (RT) and surgery. Neurocognitive outcomes were evaluated in 103 pediatric brain tumor patients (proton RT = 26, photon RT = 30, surgery = 47) before and after treatment. Comparison of neurocognitive outcomes following different treatment modalities were analyzed over four years after treatment completion. Longitudinal analyses included 42 months of follow-up after proton RT and 55 months after photon RT and surgery. Neurocognitive assessment included standardized tests examining seven domains. A comparison of neurocognitive outcomes after RT (proton and photon with >90% additional surgery) and surgery showed no significant differences in any neurocognitive domain. Neurocognitive functioning tests after proton RT failed to identify alterations compared to baseline testing. Long-term follow up over four years after photon RT showed a decrease in non-verbal intelligence (-9.6%; = 0.01) and visuospatial construction (-14.9%; = 0.02). After surgery, there was a decline in non-verbal intelligence (-10.7%; = 0.01) and processing speed (14.9%; = 0.002). Differences in neurocognitive outcomes between RT and surgical cohorts in direct intermodal comparison at long-term follow-up were not identified in our study, suggesting that modern radiation therapy does not affect cognition as much as in the past. There were no alterations in long-term neurocognitive abilities after proton RT, whereas decline of processing speed, non-verbal intelligence, and visuospatial abilities were observed after both photon RT and surgery. Domains dependent on intact white matter structures appear particularly vulnerable to brain tumor treatment irrespective of treatment approach.
先进的放射技术可以降低年轻脑肿瘤患者神经认知后遗症的严重程度。在本分析中，我们试图比较质子放疗与接受光子放疗（RT）和手术的患者的神经认知结果。在治疗前后对103例儿科脑肿瘤患者（质子放疗 = 26例，光子放疗 = 30例，手术 = 47例）的神经认知结果进行了评估。在治疗完成后的四年内分析了不同治疗方式后的神经认知结果比较。纵向分析包括质子放疗后42个月的随访以及光子放疗和手术后55个月的随访。神经认知评估包括检查七个领域的标准化测试。放疗（质子和光子放疗且额外手术率>90%）和手术后神经认知结果的比较显示，在任何神经认知领域均无显著差异。与基线测试相比，质子放疗后的神经认知功能测试未发现改变。光子放疗后四年的长期随访显示非言语智力下降（-9.6%；P = 0.01）和视觉空间构建能力下降（-14.9%；P = 0.02）。手术后，非言语智力下降（-10.7%；P = 0.01）和处理速度下降（14.9%；P = 0.002）。在我们的研究中，未发现长期随访时放疗和手术队列在直接多模式比较中的神经认知结果差异，这表明现代放射治疗对认知的影响不如过去那么大。质子放疗后长期神经认知能力没有改变，而光子放疗和手术后均观察到处理速度、非言语智力和视觉空间能力下降。无论治疗方法如何，依赖完整白质结构的领域似乎特别容易受到脑肿瘤治疗的影响。
