Zegers C M L, Offermann C, Dijkstra J, Compter I, Hoebers F J P, de Ruysscher D, Anten M M, Broen M P G, Postma A A, Hoeben A, Hovinga K E, Van Elmpt W, Eekers D B P
Department of Radiation Oncology (Maastro), Maastricht University Medical Center+, GROW-School for Oncology and Reproduction, Maastricht, the Netherlands.
Department of Medical Psychology Maastricht University Medical Center+, MHeNs School for Mental Health and Neuroscience, Maastricht, the Netherlands.
Clin Transl Radiat Oncol. 2023 Jul 22;42:100664. doi: 10.1016/j.ctro.2023.100664. eCollection 2023 Sep.
Radiotherapy induced impairment of cognitive function can lead to a reduced quality of life. The aim of this study was to describe the implementation and compliance of standardized neurocognitive assessment. In addition, the first results of cognitive changes for patients receiving a radiation dose to the brain are described.
Patients that received radiation dose to the brain (neuro, head and neck and prophylactic cranial irradiation between April-2019 and Dec-2021 were included. Three neuro cognitive tests were performed a verbal learning and memory test, the Hopkins Verbal Learning Test; a verbal fluency test, the Controlled Oral Word Association Test and a speed and cognitive flexibility test, the Trail Making Test A&B. Tests were performed before the start of radiation, 6 months (6 m) and 1 year (1y) after irradiation. The Reliable Change Index (RCI) between baseline and follow-up was calculated using reference data from literature.
644 patients performed the neurocognitive tests at baseline, 346 at 6 months and 205 at 1y after RT, with compliance rates of 90.4%, 85.6%, and 75.3%, respectively. Reasons for non-compliance were: 1. Patient did not attend appointment (49%), 2. Patient was unable to perform the test due to illness (12%), 3. Patient refused the test (8 %), 4. Various causes, (31%). A semi-automated analysis was developed to evaluate the test results. In total, 26% of patients showed a significant decline in at least one of variables at 1y and 11% on at least 2 variables at 1y. However, an increase in cognitive performance was observed in 49% (≥1 variable) and 22% (≥2 variables).
Standardized neurocognitive testing within the radiotherapy clinic was successfully implemented, with a high patient compliance. A semi-automatic method to evaluate cognitive changes after treatment was defined. Data collection is ongoing, long term follow-up (up to 5 years after treatment) and dose-effect analysis will be performed.
放射治疗引起的认知功能损害会导致生活质量下降。本研究的目的是描述标准化神经认知评估的实施情况和依从性。此外，还描述了接受脑部放射剂量患者认知变化的初步结果。
纳入2019年4月至2021年12月期间接受脑部放射剂量（神经、头颈部和预防性颅脑照射）的患者。进行了三项神经认知测试：一项言语学习和记忆测试，即霍普金斯言语学习测试；一项言语流畅性测试，即受控口语单词联想测试；以及一项速度和认知灵活性测试，即连线测验A和B。测试在放疗开始前、放疗后6个月（6m）和1年（1y）进行。使用文献中的参考数据计算基线与随访之间的可靠变化指数（RCI）。
644例患者在基线时进行了神经认知测试，放疗后6个月有346例，1年时有205例，依从率分别为90.4%、85.6%和75.3%。不依从的原因有：1.患者未赴约（49%），2.患者因病无法进行测试（12%），3.患者拒绝测试（8%），4.各种原因（31%）。开发了一种半自动分析方法来评估测试结果。总体而言，26%的患者在1年时至少有一个变量显著下降，11%的患者在1年时至少有两个变量显著下降。然而，49%（≥1个变量）和22%（≥2个变量）的患者观察到认知表现有所提高。
放疗诊所内成功实施了标准化神经认知测试，患者依从性高。定义了一种评估治疗后认知变化的半自动方法。数据收集正在进行中，将进行长期随访（治疗后长达5年）和剂量效应分析。
