A prospective study of corpus callosum regional volumes and neurocognitive outcomes following cranial radiation for pediatric brain tumors.
A prospective study of corpus callosum regional volumes and neurocognitive outcomes following cranial radiation for pediatric brain tumors.
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一项关于小儿脑肿瘤颅放射治疗后胼胝体区域体积和神经认知结果的前瞻性研究。
DOI：
10.1007/s00381-017-3412-3
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发表时间：
2017
期刊：
影响因子：
--
通讯作者：
Terezakis,Stephanie
中科院分区：
文献类型：
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作者：
Rashid,Arif;Ram,AshwinN;Kates,WendyR;Redmond,KristinJ;Wharam,Moody;MarkMahone,E;Horska,Alena;Terezakis,Stephanie
目的/目标颅脑放射治疗 (CRT) 可能会破坏胼胝体 (CC)，而胼胝体在基本运动和认知功能中发挥着重要作用。这项前瞻性纵向研究的目的是评估 CRT 后儿童 CC 中矢状区域、CC 体积以及与 CC 相关的神经心理学 (NP) 测试表现的变化。 材料/方法 12 名儿童患者因原发性脑恶性肿瘤接受 CRT 治疗。十三名年龄匹配的健康志愿者作为对照。在基线以及 CRT 完成后 6、15 和 27 个月时进行了脑 MRI 和 NP 评估，强调运动灵活性、处理速度、视觉运动整合和工作记忆（视觉和语言）。线性混合效应 (LME) 分析用于评估患者 NP 表现以及区域 CC 体积（膝部、前体、中体、后体和压部）和中矢状区域随时间和辐射剂量的变化，并校正 CRT 开始时的年龄。结果 CRT 的平均年龄为 9.41（范围 1.2-15.7）岁。中位处方剂量为 54（范围 18-59.4）Gy。 LME 分析显示，随着时间的推移，总 CC 体积显着下降 (p< 0.00001)，而辐射剂量没有总体影响。对各个 CC 区域的分析表明，随着时间的推移，患者的所有区域体积均显着减少 (p< 0.00001)，且辐射剂量没有影响。仅在压部存在剂量依赖性效应的趋势 (p= 0.093)。就诊期间，患者的 NP 表现显着下降，尤其是运动灵活性和视觉工作记忆方面（均< 0.0001）。结论这些前瞻性数据表明，CRT 后 CC 区域体积显着下降，神经认知功能也随之下降，尤其是手动灵活性、注意力和工作记忆方面。需要对更大的患者群体进行进一步的前瞻性研究，以确定 CRT 剂量、神经解剖学和 CC 功能变化之间的关系。
Purpose/objective(s)Cranial radiation therapy (CRT) may disrupt the corpus callosum (CC), which plays an important role in basic motor and cognitive functions. The aim of this prospective longitudinal study was to assess changes in CC mid-sagittal areas, CC volumes, and performance on neuropsychological (NP) tests related to the CC in children following CRT.Materials/methodsTwelve pediatric patients were treated with CRT for primary brain malignancies. Thirteen age-matched healthy volunteers served as controls. Brain MRIs and NP assessment emphasizing motor dexterity, processing speed, visuomotor integration, and working memory (visual and verbal) were performed at baseline and at 6, 15, and 27 months following completion of CRT. Linear mixed effects (LME) analyses were used to evaluate patient NP performance and changes in regional CC volumes (genu, anterior body, mid-body, posterior body, and splenium) and mid-sagittal areas over time and with radiation doses, correcting for age at CRT start.ResultsThe mean age at CRT was 9.41 (range 1.2–15.7) years. The median prescription dose was 54 (range 18–59.4) Gy. LME analysis revealed a significant decrease in overall CC volumes over time (p< 0.00001), with no overall effect of radiation dose. Analysis of individual CC regions demonstrated a significant decrease in all regional volumes over time (p< 0.00001) in patients, with no effect of radiation dose. Only in the splenium was there a trend toward a dose-dependent effect (p= 0.093). Patients had significantly reduced NP performance across visits—most notably in motor dexterity and visual working memory (bothp< 0.0001).ConclusionsThese prospective data demonstrate a significant decrease in CC regional volumes after CRT, with associated decline in neurocognitive function, most notably in manual dexterity, attention, and working memory. Further prospective study of larger cohorts of patients is needed to establish the relationship between CRT dose, neuroanatomical, and functional changes in the CC.