Abstract

Background

The objective of this study was to evaluate the contribution of radiation dose to different intracranial structures on changes in intellectual function for children with brain tumors.

Methods

We evaluated children with brain tumors treated in 2005–2017 who had longitudinal neuropsychological assessments and available photon dosimetric data (if radiation therapy [RT] given). Full Scale Intelligence Quotient (FSIQ) and index scores were evaluated (perceptual reasoning index [PRI], processing speed index [PSI], verbal comprehension index [VCI], and working memory index [WMI]). Multivariable linear mixed effects models were used to model endpoints, with age at RT and dose to different brain regions as fixed effects and patient-specific random intercepts. P-values (P*) were adjusted for multiple comparisons.

Results

Sixty-nine patients were included, 56 of whom received RT. Median neuropsychological follow-up was 3.2 years. Right temporal lobe mean dose was strongly associated with decline in FSIQ (P* = 0.005); with each gray increase in mean dose, there was a decrease of 0.052 FSIQ points per year. Dose to 50% (D50) of the supratentorial brain was associated with decline in PSI (P* = 0.006) and WMI (P* = 0.001). Right and left hippocampus D50 were individually strongly associated with declines in VCI (P* = 0.009 for each). Presence of a ventriculoperitoneal shunt decreased FSIQ by 10 points.

Conclusions

We reported associations between dosimetry to specific brain regions and intellectual outcomes, with suggested avoidance structures during RT planning. These models can help clinicians anticipate changes in neurocognition post-RT and guide selection of an optimal RT plan.

中文翻译：

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脑肿瘤儿童放疗后的智力变化：哪些大脑结构最重要？

摘要

背景

本研究的目的是评估辐射剂量对不同颅内结构的影响对脑肿瘤儿童智力功能变化的影响。

方法

我们评估了 2005-2017 年接受治疗的脑肿瘤儿童，他们进行了纵向神经心理学评估和可用的光子剂量学数据（如果给予放射治疗 [RT]）。评估了全面智商 (FSIQ) 和指数分数（感知推理指数 [PRI]、处理速度指数 [PSI]、言语理解指数 [VCI] 和工作记忆指数 [WMI]）。多变量线性混合效应模型用于模拟终点，将放疗年龄和不同大脑区域的剂量作为固定效应和患者特定的随机截距。针对多重比较调整P 值(P*)。

结果

包括 69 名患者，其中 56 名接受了放疗。中位神经心理学随访时间为 3.2 年。右颞叶平均剂量与 FSIQ 下降密切相关（P * = 0.005）；平均剂量每增加一个灰色，每年就会减少 0.052 FSIQ 点。幕上大脑 50% (D50) 的剂量与 PSI ( P * = 0.006) 和 WMI ( P * = 0.001) 的下降有关。左右海马 D50 分别与 VCI 的下降密切相关（每个P * = 0.009）。脑室腹腔分流术的存在使 FSIQ 降低了 10 分。

结论

我们报告了特定大脑区域的剂量学与智力成果之间的关联，并在 RT 计划期间建议了避免结构。这些模型可以帮助临床医生预测放疗后神经认知的变化，并指导选择最佳放疗计划。