Sekely Angela, Tsang Derek S, Mabbott Donald, Kongkham Paul, Zadeh Gelareh, Zakzanis Konstantine K, Edelstein Kim
Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada.
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Neurooncol Pract. 2022 Feb 19;9(3):208-218. doi: 10.1093/nop/npac011. eCollection 2022 May.
Although radiation (RT) is standard treatment for many brain tumors, it may contribute to neurocognitive decline. The objective of this study was to investigate associations between RT dose to circumscribed brain regions and specific neurocognitive domains in patients with meningioma.
We undertook a retrospective study of 40 patients with meningioma who received RT and underwent an in-depth clinical neurocognitive assessment. Radiation dosimetry characteristics were delineated based on treatment planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Principal components analysis was applied to organize neurocognitive test scores into factors, and multivariate multiple linear regression models were undertaken to examine if RT dose to circumscribed brain regions is associated with specific neurocognitive outcomes.
Radiation dose to brain regions was associated with neurocognitive functions across a number of domains. High dose to the parietal-occipital region was associated with slower visuomotor processing speed (mean dose, β = -1.100, = .017; dose to 50% of the region [D50], β = -0.697, = .049). In contrast, high dose to the dorsal frontal region was associated with faster visuomotor processing speed (mean dose, β = 0.001, = .036).
These findings suggest that RT delivered to brain regions (ie, parietal-occipital areas) may contribute to poor neurocognitive outcomes. Given that modern radiotherapy techniques allow for precise targeting of dose delivered to brain regions, prospective trials examining relations between dose and neurocognitive functions are warranted to confirm these preliminary results.
尽管放射治疗（RT）是许多脑肿瘤的标准治疗方法，但它可能会导致神经认知功能下降。本研究的目的是调查脑膜瘤患者特定脑区的放疗剂量与特定神经认知领域之间的关联。
我们对40例接受放疗并进行了深入临床神经认知评估的脑膜瘤患者进行了一项回顾性研究。基于与对比增强3D T1加权磁共振成像共同配准的治疗计划计算机断层扫描，描绘放射剂量学特征。应用主成分分析将神经认知测试分数组织成因素，并采用多元多重线性回归模型来检验特定脑区的放疗剂量是否与特定神经认知结果相关。
脑区的放射剂量与多个领域的神经认知功能相关。顶枕区高剂量与视觉运动处理速度较慢有关（平均剂量，β = -1.100，P = .017；该区域50%的剂量[D50]，β = -0.697，P = .049）。相比之下，背侧额叶高剂量与视觉运动处理速度较快有关（平均剂量，β = 0.001，P = .036）。
这些发现表明，给予脑区（即顶枕区）的放疗可能导致不良的神经认知结果。鉴于现代放疗技术能够精确靶向给予脑区的剂量，有必要进行前瞻性试验来研究剂量与神经认知功能之间的关系，以证实这些初步结果。
