Doig Mikaela, Lee Jae, Kwok Young, MacEwan Iain, Wolden Suzanne, Allison Keith, Dennehy Sara, Bajaj Benjamin, Short Michala, Gorayski Peter, Bezak Eva, Yock Torunn I
Allied Health and Human Performance Academic Unit, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia.
J Neurooncol. 2025 Sep 9. doi: 10.1007/s11060-025-05211-w.
Cranial irradiation is associated with health-related quality of life (HRQoL) deficits in childhood cancer survivors. We investigated the relationship between radiation dose to brain substructures and HRQoL in children with brain tumors treated with proton beam therapy (PBT).
Data were obtained from children in the Pediatric Proton/Photon Consortium Registry who received PBT for primary brain tumors between 2015 and 2021. HRQoL was assessed using PedsQL Generic Core questionnaires during the first week of PBT and annually thereafter. Standardized substructure segmentations and dosimetry data were correlated with parent-proxy reported HRQoL scores using Pearson correlations.
Seventy-six patients were included, with median age 8.9 years (range 1.2-16.5) at diagnosis. Median follow-up was 5.0 years post-PBT and median prescribed dose was 54Gy. HRQoL scores were lower than normative population values during PBT, particularly in those who received craniospinal irradiation (CSI) (p < 0.05). Across the total cohort, higher mean doses to the whole brain, supratentorial brain, corpus callosum, left hippocampus, hypothalamus, optic chiasm, pituitary and thalamus correlated with worse HRQoL (r= -0.24 to -0.39), p < 0.05). In the CSI subgroup (n = 17), moderate-to-strong associations between dose to these structures and physical functioning (r= -0.50 to -0.79, p < 0.05) were observed. In children who received focal PBT (n = 59), weaker associations were observed between dose to the hypothalamus and pituitary, and HRQoL (r = -0.28 to -0.36, p < 0.05).
Higher radiation doses to specific brain substructures were associated with poorer HRQoL outcomes after PBT. Minimizing dose to these areas during treatment planning may help preserve HRQoL in survivors.
颅脑照射与儿童癌症幸存者的健康相关生活质量（HRQoL）缺陷有关。我们研究了质子束治疗（PBT）的脑肿瘤患儿脑部亚结构的辐射剂量与HRQoL之间的关系。
数据来自儿科质子/光子联盟登记处的儿童，这些儿童在2015年至2021年间接受了PBT治疗原发性脑肿瘤。在PBT的第一周及之后每年使用儿童生活质量通用核心问卷评估HRQoL。标准化的亚结构分割和剂量测定数据与家长代理报告的HRQoL分数使用Pearson相关性进行关联。
纳入76例患者，诊断时中位年龄8.9岁（范围1.2 - 16.5岁）。PBT后中位随访时间为5.0年，中位处方剂量为54Gy。在PBT期间，HRQoL分数低于正常人群值，尤其是接受全脑脊髓照射（CSI）的患者（p < 0.05）。在整个队列中，全脑、幕上脑、胼胝体、左侧海马体、下丘脑、视交叉、垂体和丘脑的较高平均剂量与较差的HRQoL相关（r = -0.24至-0.39），p < 0.05）。在CSI亚组（n = 17）中，观察到这些结构的剂量与身体功能之间存在中度至强关联（r = -0.50至-0.79，p < 0.05）。在接受局部PBT的儿童（n = 59）中，观察到下丘脑和垂体的剂量与HRQoL之间的关联较弱（r = -0.28至-0.36，p < 0.05）。
特定脑亚结构的较高辐射剂量与PBT后较差的HRQoL结果相关。在治疗计划期间将这些区域的剂量降至最低可能有助于保护幸存者的HRQoL。
