BACKGROUND Neurocognitive function of adult patients with brain tumours may deteriorate after radiotherapy. Proton beam therapy (PBT) reduces the volume of irradiated healthy brain tissue and could potentially preserve neurocognition and quality of life (QoL). As present data are still limited, the impact of clinical factors and dosimetric parameters on neurocognitive function and QoL during recurrence-free follow-up after PBT is investigated. METHODS The current study includes 62 brain tumour patients treated with PBT between 2015 and 2017. Neurocognition and QoL were assessed at baseline and every 3 months after PBT using the Montreal Cognitive Assessment (MoCA) test together with EORTC-QLQ-C30 and BN20 questionnaires, respectively. Objective and self-reported measures of neurocognitive functions were correlated. During two years of follow-up, the impact of clinical co-factors as well as dosimetric parameters of several brain structures were analysed using a mixed-model approach. RESULTS At baseline, mean MoCA total score was 24.8/30 and self-reported cognitive function was 68.9/100. Both remained stable over time. Patients with impaired neurocognition on the MoCA test reported significantly lower global health status, cognitive, physical and role function as well as more fatigue, pain, headache and communication deficits compared to normal performing patients. For most follow-up time points, the majority of MoCA subitems correlated significantly to QoL items regarding neurocognition. Slight deterioration of the MoCA score was associated with tumours located in the left hemisphere and with an increase in relative volume of the anterior cerebellum that received doses of 30-40 Gy(RBE). CONCLUSION Self-reported and objectively measured neurocognition and most other QoL domains remained largely stable over time during recurrence-free follow-up for brain tumour patients treated with PBT. The association between reduced cognitive function and irradiated volume of the anterior cerebellum requires validation in larger studies and comparison to patients treated with photon therapy.

中文翻译：

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脑肿瘤患者质子束治疗后的神经认知功能和生活质量

背景技术脑肿瘤成年患者放疗后神经认知功能可能会恶化。质子束疗法 (PBT) 可减少受照射的健康脑组织的体积，并有可能保护神经认知和生活质量 (QoL)。由于目前的数据仍然有限，因此研究了 PBT 后无复发随访期间临床因素和剂量学参数对神经认知功能和 QoL 的影响。方法 目前的研究包括 2015 年至 2017 年间接受 PBT 治疗的 62 名脑肿瘤患者。使用蒙特利尔认知评估 (MoCA) 测试以及 EORTC-QLQ-C30 和 BN20 问卷，在基线和 PBT 后每 3 个月评估神经认知和 QoL，分别。神经认知功能的客观和自我报告的测量是相关的。在两年的随访中，使用混合模型方法分析了临床辅助因素的影响以及几种大脑结构的剂量学参数。结果 在基线时，平均 MoCA 总分为 24.8/30，自我报告的认知功能为 68.9/100。随着时间的推移，两者都保持稳定。与表现正常的患者相比，在 MoCA 测试中神经认知受损的患者报告的整体健康状况、认知、身体和角色功能显着降低，以及更多的疲劳、疼痛、头痛和沟通障碍。对于大多数随访时间点，大多数 MoCA 子项目与关于神经认知的 QoL 项目显着相关。MoCA 评分的轻微恶化与位于左半球的肿瘤以及接受 30-40 Gy(RBE) 剂量的小脑前部的相对体积增加有关。结论 在接受 PBT 治疗的脑肿瘤患者的无复发随访期间，自我报告和客观测量的神经认知和大多数其他 QoL 域在很大程度上保持稳定。认知功能降低与小脑前部受照射体积之间的关联需要在更大规模的研究中进行验证，并与接受光子治疗的患者进行比较。