Radiotherapy-induced neurocognitive decline among adult intracranial tumor patients: A voxel-based approach

认知功能衰退 神经认知 神经心理学 体素 认知 波士顿命名测验 医学 听力学 心理学 痴呆 核医学 内科学 放射科 精神科 疾病
作者
Charlotte Sleurs,Catharina M.L. Zegers,Marvin Ribeiro,Wouter van Elmpt,Jeanette Dijkstra,Alida A. Postma,Laurien De Roeck,Karin Gehring,Wouter De Baene,Margriet M. Sitskoorn,Maarten Lambrecht,Daniëlle B. P. Eekers
出处
期刊:Neuro-oncology [Oxford University Press]
卷期号:27 (10): 2634-2646
标识
DOI:10.1093/neuonc/noaf114
摘要

Abstract Background Cranial irradiation is a key component of neuro-oncological treatment but can result in cognitive side effects. Preserving cognition from radiotherapy-(RT)-induced toxicity remains an ongoing debate. To spatially map radiotoxic effects in patients who underwent cranial RT, this study applied a voxel-based approach. Methods Cognitive assessments (Controlled Word Association (COWA), Hopkins Verbal Learning (HVLT-R), and Trail Making Tests (TMT A,B)) were conducted prospectively before, 6 months and 1 year post-RT in 111 intracranial tumor patients (18–80 years). Reliable change indices indicated cognitive changes across timepoints. CT and T1-weighted MRI scans acquired at diagnosis were co-registered, normalized to standard space, and smoothed. Voxel-wise permutation-based regression analyses examined the relationship between RT dose and cognitive decline (α < 0.05 at cluster level). Results Images of 111 patients (Mdn age = 55.39 years; 47% male; lesions were gliomas (61%), meningiomas (18%), other (21%); in frontal (33%), temporal (25%), other location (42%)) were analyzed. Reliable decline was most pronounced at 6 months, particularly on the TMT A (25.77%), TMT B (24.21%), and HVLT immediate recall (21%). At 1 year, 20% of patients continued to show a decline in TMT B. Higher RT doses to frontal gyri, temporal, occipital, and para-central regions were associated with declines in verbal fluency, memory, processing speed, and flexibility at both peak- and cluster-level. Conclusion Differential voxel-wise RT dose effects at peak versus cluster level suggest local and network-based recruitment of diverse functional regions and vulnerability to cranial RT. These insights may help re-define key regions at risk from a network-based perspective, preserving cognition in future RT planning.
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