De Roeck Laurien, Colaes Rob, Dupont Patrick, Sunaert Stefan, De Vleeschouwer Steven, Clement Paul M, Sleurs Charlotte, Lambrecht Maarten
Department of Oncology, KU Leuven, Belgium.
Department of Radiation-Oncology, University Hospitals Leuven, Belgium.
Neurooncol Adv. 2025 Jul 18;7(1):vdaf163. doi: 10.1093/noajnl/vdaf163. eCollection 2025 Jan-Dec.
Emerging evidence suggests that cognitive dysfunction may result from damage to the brain's functional network. This study explores the dose-dependent susceptibility of functional hubs to radiotherapy (RT) and associations with cognitive outcomes.
Attention, language, memory, motor, and executive functioning were assessed ≥1-year post-radiotherapy in 39 WHO grade 2 or 3 glioma patients with lesions predominantly located in the left frontal lobe and 50 matched healthy controls. Using resting-state functional imaging, weighted functional graphs were constructed for each participant, identifying hubs through graph measures. Linear regression models and Spearman's rho correlations assessed associations between mean RT dose per region and cognitive domains.
Higher RT doses to the left fusiform and inferior temporal gyri were linked to memory impairment (r(37) ≥ -0.565, ≤ 0.026), while poorer language outcomes were associated with higher doses to the left pars opercularis, rostral middle frontal gyrus, and caudate (r(37) ≥ -0.510, ≤ .040). Attention deficits were linked to higher doses to the left posterior cingulate, precentral, supramarginal, and postcentral gyrus ((37) ≥ -0.499, ≤ .040), with the left postcentral gyrus also associated with executive dysfunction (r(37) = -0.526, = .029). Significant correlations between RT dose and cognitive outcomes were more frequent in hubs than in non-hubs (50% vs. 12%, = .005) and exclusively found in left-sided regions.
RT seems to adversely affect left-sided functional hubs in a dose-dependent manner in glioma patients, which may contribute to cognitive dysfunction. Protecting these regions from the dose may potentially mitigate cognitive side effects in glioma patients. However, since most lesions were located in the left hemisphere and baseline testing was unavailable, a potential effect of tumor location cannot be entirely ruled out.
新出现的证据表明，认知功能障碍可能源于大脑功能网络的损伤。本研究探讨功能枢纽对放射治疗（RT）的剂量依赖性易感性以及与认知结果的关联。
对39例世界卫生组织2级或3级胶质瘤患者（病变主要位于左额叶）和50例匹配的健康对照者在放疗后≥1年进行注意力、语言、记忆、运动和执行功能评估。利用静息态功能成像，为每个参与者构建加权功能图，通过图测量识别枢纽。线性回归模型和斯皮尔曼等级相关分析评估每个区域的平均放疗剂量与认知领域之间的关联。
左梭状回和颞下回接受较高放疗剂量与记忆障碍有关（r(37) ≥ -0.565，P ≤ 0.026），而较差的语言结果与左岛盖部、额中回前部和尾状核接受较高剂量有关（r(37) ≥ -0.510，P ≤ .040）。注意力缺陷与左后扣带回、中央前回、缘上回和中央后回接受较高剂量有关（r(37) ≥ -0.499，P ≤ .040），左中央后回也与执行功能障碍有关（r(37) = -0.526，P = .029）。放疗剂量与认知结果之间的显著相关性在枢纽中比在非枢纽中更常见（50%对12%，P = .005），且仅在左侧区域发现。
放疗似乎以剂量依赖性方式对胶质瘤患者的左侧功能枢纽产生不利影响，这可能导致认知功能障碍。保护这些区域免受高剂量照射可能会减轻胶质瘤患者的认知副作用。然而，由于大多数病变位于左半球且无法进行基线测试，肿瘤位置的潜在影响不能完全排除。
