Background

The number of pediatric brain tumor survivors are increasing due to improved treatment protocols and multimodal treatments. Many survivors have neurocognitive sequelae, especially after radiotherapy. Neuropsychological assessment is therefore essential to interpret clinical outcome, evaluate treatments protocol and implement rehabilitation interventions. The overall aim of this study was to describe neurocognitive functions before and after radiotherapy. We also aimed to explore potential confounding risk factors that could affect the interpretation of radiotherapy-induced neurocognitive decline.

Material and methods

50 pediatric brain tumor survivors that had received radiotherapy (>5 years) were included. Clinical characteristics, potential confounding risk factors, radiotherapy plans and neurocognitive functions on IQ and neuropsychological measurements were analyzed before and after radiotherapy.

Results

Neurocognitive functions were affected before radiotherapy and were progressively aggravated thereafter. The last neuropsychological assessment after radiotherapy varied between 2-139 months. 19 patients were tested five years after radiotherapy and 90% of them performed >1SD below the normative mean on IQ measurements. Several potential confounding risk factors including those induced by radiotherapy were associated with lower performance on perceptual function, working memory and processing speed. Longer time after radiotherapy was particularly associated with lower performance on working memory and processing speed. Importantly, the neuropsychological assessments revealed more comprehensive problems than could be inferred from IQ measurements alone.

Conclusion

Our study underpins the importance of systematic and structured neuropsychological assessment before and after radiotherapy. The timing of the assessment is important and potential confounding risk factors need to be identified to better evaluate radiotherapy-induced neurocognitive decline.

中文翻译：

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小儿脑肿瘤幸存者放疗前后的神经认知功能

背景

由于改进的治疗方案和多模式治疗，小儿脑肿瘤幸存者的数量正在增加。许多幸存者有神经认知后遗症，尤其是在放疗后。因此，神经心理学评估对于解释临床结果、评估治疗方案和实施康复干预至关重要。本研究的总体目的是描述放疗前后的神经认知功能。我们还旨在探索可能影响对放射治疗引起的神经认知衰退的解释的潜在混杂风险因素。

材料与方法

纳入了 50 名接受过放射治疗（ > 5 年）的小儿脑肿瘤幸存者。分析了放疗前后的临床特征、潜在的混杂危险因素、放疗计划和神经认知功能对智商和神经心理测量的影响。

结果

神经认知功能在放疗前受到影响，之后逐渐加重。放疗后的最后一次神经心理学评估在 2-139 个月之间变化。19 名患者在放疗 5 年后接受了测试，其中 90% 的IQ 测量值低于标准平均值> 1SD。包括放射治疗在内的几个潜在的混杂风险因素与感知功能、工作记忆和处理速度的较低表现有关。放疗后的较长时间与工作记忆和处理速度的较低表现特别相关。重要的是，神经心理学评估揭示了比仅从 IQ 测量中推断出的更全面的问题。

结论

我们的研究强调了放射治疗前后系统和结构化的神经心理学评估的重要性。评估的时机很重要，需要确定潜在的混杂风险因素，以更好地评估放疗引起的神经认知衰退。