Department of Pediatrics and Adolescence Medicine, Oulu University Hospital, and Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland.
Department of Child Neurology, New Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland.
Neuro Oncol. 2024 Feb 2;26(2):362-373. doi: 10.1093/neuonc/noad186.
Studies have established that radiotherapy for childhood brain tumors (BTs) increases the risk of cerebrovascular disease (CVD); however, it is unclear how this will affect cognitive function. This study aimed to investigate the associations between radiotherapy-induced CVD, white matter hyperintensities (WMHs), and neurocognitive outcomes in adult survivors of childhood BTs.
In a cross-sectional setting, we conducted a national cohort that included 68 radiotherapy-treated survivors of childhood BTs after a median follow-up of 20 years. Markers of CVD and WMHs were evaluated using brain MRI, and the sum of CVD-related findings was calculated. Additionally, the associations among CVD findings, WMHs, and neuropsychological test results were analyzed.
Of the 68 childhood BT survivors, 54 (79%) were diagnosed with CVD and/or WMHs at a median age of 27 years. CVD and/or WMHs were associated with lower scores for verbal intelligence quotient, performance intelligence quotient (PIQ), executive function, memory, and visuospatial ability (P < .05). Additionally, survivors with microbleeds had greater impairments in the PIQ, processing speed, executive function, and visuospatial ability (P < .05). WMHs and CVD burden were associated with greater difficulties in memory function and visuospatial ability (P < .05). Small-vessel disease burden was associated with PIQ scores, processing speed, working memory, and visuospatial ability.
The study results suggest that markers of radiotherapy-induced CVD, the additive effect of CVD markers, and risk factors of dementia are associated with cognitive impairment, which may suggest that the survivors are at a high risk of developing early-onset dementia.
研究已经证实，儿童脑肿瘤（BTs）的放射治疗会增加脑血管疾病（CVD）的风险；然而，目前尚不清楚这将如何影响认知功能。本研究旨在探讨放射治疗引起的 CVD、脑白质高信号（WMHs）与儿童 BT 后成年幸存者神经认知结局之间的关系。
在一项横断面研究中，我们对接受了中位数为 20 年随访的 68 名接受过放射治疗的儿童 BT 幸存者进行了全国性队列研究。使用脑部 MRI 评估 CVD 和 WMHs 的标志物，并计算 CVD 相关发现的总和。此外，还分析了 CVD 发现、WMHs 与神经心理学测试结果之间的关系。
在 68 名儿童 BT 幸存者中，54 名（79%）在中位数年龄为 27 岁时被诊断出患有 CVD 和/或 WMHs。CVD 和/或 WMHs 与言语智商、表现智商（PIQ）、执行功能、记忆和视空间能力的得分较低相关（P <.05）。此外，有微出血的幸存者在 PIQ、处理速度、执行功能和视空间能力方面的损伤更大（P <.05）。WMHs 和 CVD 负担与记忆功能和视空间能力的更大困难相关（P <.05）。小血管疾病负担与 PIQ 评分、处理速度、工作记忆和视空间能力相关。
研究结果表明，放射治疗引起的 CVD 标志物、CVD 标志物的累加效应以及痴呆的危险因素与认知障碍有关，这可能表明幸存者有很高的患早发性痴呆的风险。
