Department of Psychology, Lund University, Lund, Sweden.
Department of Paediatrics, Skåne University Hospital, Lund, Sweden.
Child Neuropsychol. 2024 Feb;30(1):22-44. doi: 10.1080/09297049.2023.2172149. Epub 2023 Feb 6.
Survivors of Pediatric Brain Tumors (PBTs) treated with cranial radiation therapy (CRT) often experience a decline in neurocognitive test scores. Less is known about the neurocognitive development of non-irradiated survivors of PBTs. The aim of this study was to statistically model neurocognitive development after PBT in both irradiated and non-irradiated survivors and to find clinical variables associated with the rate of decline in neurocognitive scores. A total of 151 survivors were included in the study. Inclusion criteria: Diagnosis of PBT between 2001 and 2013 or earlier diagnosis of PBT and turning 18 years of age between 2006 and 2013. Exclusion criteria: Death within a year from diagnosis, neurocutaneous syndromes, severe intellectual disability. Clinical neurocognitive data were collected retrospectively from medical records. Multilevel linear modeling was used to evaluate the rate of decline in neurocognitive measures and factors associated with the same. A decline was found in most measures for both irradiated and non-irradiated survivors. Ventriculo-peritoneal (VP) shunting and treatment with whole-brain radiation therapy (WBRT) were associated with a faster decline in neurocognitive scores. Male sex and supratentorial lateral tumor were associated with lower scores. Verbal learning measures were either stable or improving. Survivors of PBTs show a pattern of decline in neurocognitive scores irrespective of treatment received, which suggests the need for routine screening for neurocognitive rehabilitation. However, survivors treated with WBRT and/or a VP shunt declined at a faster rate and appear to be at the highest risk of negative neurocognitive outcomes and to have the greatest need for neurocognitive rehabilitation.
接受颅放射治疗（CRT）的小儿脑肿瘤（PBT）幸存者常出现神经认知测试分数下降。而非接受放射治疗的 PBT 幸存者的神经认知发展情况则知之甚少。本研究旨在通过对接受和未接受放射治疗的 PBT 幸存者进行统计建模，分析其神经认知发展情况，并找出与神经认知评分下降速度相关的临床变量。共有 151 名幸存者纳入本研究。纳入标准：2001 年至 2013 年间诊断为 PBT 或 2006 年至 2013 年间更早诊断为 PBT 且年满 18 岁。排除标准：诊断后一年内死亡、神经皮肤综合征、严重智力障碍。临床神经认知数据从病历中回顾性收集。采用多级线性模型评估神经认知测量值的下降速度及与下降速度相关的因素。发现接受和未接受放射治疗的幸存者的大多数神经认知测量值都出现下降。脑室-腹腔（VP）分流和全脑放射治疗（WBRT）与神经认知评分的快速下降相关。男性和幕上外侧肿瘤与较低的评分相关。言语学习测量值稳定或提高。无论接受何种治疗，PBT 幸存者的神经认知评分都呈下降趋势，这表明需要进行常规的神经认知康复筛查。然而，接受 WBRT 和/或 VP 分流治疗的幸存者下降速度更快，似乎面临着最严重的负面神经认知后果风险，也最需要神经认知康复。
