Pediatric Neurology Department, Children's Hospital, Toulouse University Hospital, France; Toulouse NeuroImaging Center (ToNIC), INSERM University of Toulouse Paul Sabatier, France.
Pediatric Neurology Department, Children's Hospital, Toulouse University Hospital, France; Toulouse NeuroImaging Center (ToNIC), INSERM University of Toulouse Paul Sabatier, France.
Radiother Oncol. 2022 Sep;174:111-122. doi: 10.1016/j.radonc.2022.05.022. Epub 2022 May 29.
In recent years, progress in pediatric posterior fossa tumor (PFT) treatments has improved survival rates. However, the majority of survivors present neurocognitive sequelae that impact academic achievement.
This review examines the literature from 2000 to 2020 on long-term outcomes in different memory systems for survivors of pediatric PFT, considering the impact of radiotherapy which is a well-known prognostic factor for global neurocognitive function.
Of the 43 articles selected, 31 explored working memory, 19 episodic memory, 9 semantic memory and 2 procedural memory. Irradiated survivors had scores of <-2 standard deviation (SD) (n = 4 studies/25) or between -2SD and -1SD (n = 7 studies/25) for working memory; <-1SD for anterograde memory (n = 11/13), with a progressive decline in these two memory systems; <-1SD (n = 4/7) in semantic memory, and a deficit in perceptual-motor procedural learning (n = 1/1). Reducing craniospinal irradiation dose, limiting tumor bed boosts, and using proton therapy seem to have had a beneficial effect with better preservation of the memory score and a reduction in the decline over time. Non-irradiated survivors had memory systems that were less affected, with preservation of anterograde memory and maintenance of long-term stability.
Memory deficits are a core feature in survivors of pediatric PFT, especially when treatment requires radiotherapy. To limit these effects, dose constraints for specific brain areas involved in memory should be defined. During long-term follow-up, specific attention is essential to identify these deficits in order to limit their impact on the quality of life.
近年来，小儿后颅窝肿瘤（PFT）治疗的进展提高了生存率。然而，大多数幸存者都存在影响学业成绩的神经认知后遗症。
本综述回顾了 2000 年至 2020 年期间，关于小儿 PFT 幸存者不同记忆系统长期预后的文献，同时考虑了放疗的影响，放疗是影响整体神经认知功能的一个已知预后因素。
在 43 篇入选的文章中，有 31 篇探讨了工作记忆，19 篇探讨了情景记忆，9 篇探讨了语义记忆，2 篇探讨了程序记忆。接受放疗的幸存者的工作记忆评分低于 -2 个标准差（SD）（n=4 项研究/25 人）或在 -2SD 与-1SD 之间（n=7 项研究/25 人）；顺行性记忆低于 -1SD（n=11/13），这两种记忆系统逐渐下降；语义记忆低于 -1SD（n=4/7），知觉运动程序性学习能力受损（n=1/1）。降低全脑全脊髓放疗剂量、限制肿瘤床照射剂量、使用质子治疗似乎都有有益的效果，能更好地保留记忆评分，并减少随时间的下降。未接受放疗的幸存者的记忆系统受影响较小，顺行性记忆得以保留，长期稳定性得以维持。
记忆缺陷是小儿 PFT 幸存者的一个核心特征，尤其是在需要放疗治疗时。为了限制这些影响，应该为涉及记忆的特定脑区确定剂量限制。在长期随访中，必须特别注意识别这些缺陷，以限制其对生活质量的影响。
