Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for Pediatric Medulloblastoma
Superior Intellectual Outcomes After Proton Radiotherapy Compared With Photon Radiotherapy for Pediatric Medulloblastoma
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DOI：
10.1200/jco.19.01706
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发表时间：
2020-02-10
影响因子：
45.3
通讯作者：
Mabbott, Donald
中科院分区：
文献类型：
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作者：
Kahalley, Lisa S.;Peterson, Rachel;Mabbott, Donald
目的质子放射治疗(PRT)与光子放射治疗(XRT)相比，可减少对正常组织的剂量，从而降低儿童脑肿瘤传统上与颅脑放射治疗相关的神经心理风险。我们检测了接受PRT和XRT治疗的儿童髓母细胞瘤患者的智力评分随时间的变化。方法对2007至2018年间接受相同治疗方案(PRT和XRT)的儿童患者进行智能测试，只是放射治疗方式不同。结果对79例患者(PRT 37例，XRT 42例)的纵向智力数据进行了分析。两组在大多数人口统计学/临床变量上相似，包括性别(67.1%男性)、确诊时年龄(平均8.6岁)、头颅照射剂量(中位数)、随访时间(平均4.3年)和父母教育(平均14.3年)。增强剂量(P<；.001)和增强幅度(P=.001)在不同组之间不同。调整协变量后，与XRT组相比，PRT组在整体智商(IQ)、知觉推理和工作记忆方面表现出更好的长期结果(均P<0.05)。XRT组的整体智商、工作记忆和处理速度显著下降(均为P<；0.05)。PRT组在除处理速度(P=.003)外的所有领域都表现出稳定的分数(P=.003)。结论据我们所知，这是第一项在可比的当代方案上比较髓母细胞瘤PRT和XRT治疗的儿童患者的智力轨迹的研究。与XRT相比，PRT在大多数领域都与更有利的智力结果有关，尽管加工速度对两组来说都是一个脆弱的领域。这项研究提供了迄今为止最有力的证据，证明PRT在儿童髓母细胞瘤的治疗中具有智力上的节省优势。(C)2019年美国临床肿瘤学会
PURPOSE Proton radiotherapy (PRT) may lessen the neuropsychological risk traditionally associated with cranial radiotherapy for the treatment of pediatric brain tumors by reducing the dose to normal tissue compared with that of photon radiotherapy (XRT). We examined the change in intellectual scores over time in patients with pediatric medulloblastoma treated with craniospinal PRT versus XRT.METHODS Intelligence test scores were obtained for a sample of pediatric patients treated between 2007 and 2018 on the same medulloblastoma protocols that differed only in radiotherapy modality (PRT v XRT). Growth curve analyses compared change in scores over time since diagnosis between groups.RESULTS Longitudinal intelligence data from 79 patients (37 PRT, 42 XRT) were examined. Groups were similar on most demographic/clinical variables, including sex (67.1% male), age at diagnosis (mean, 8.6 years), craniospinal irradiation dose (median, 23.4 Gy), length of follow-up (mean, 4.3 years), and parental education (mean, 14.3 years). Boost dose (P < .001) and boost margin (P = .001) differed between groups. Adjusting for covariates, the PRT group exhibited superior long-term outcomes in global intelligence quotient (IQ), perceptual reasoning, and working memory compared with the XRT group (all P < .05). The XRT group exhibited a significant decline in global IQ, working memory, and processing speed (all P < .05). The PRT group exhibited stable scores over time in all domains with the exception of processing speed (P = .003).CONCLUSION To our knowledge, this is the first study to compare intellectual trajectories between pediatric patients treated for medulloblastoma with PRT versus those treated with XRT on comparable, contemporary protocols. PRT was associated with more favorable intellectual outcomes in most domains compared with XRT, although processing speed emerged as a vulnerable domain for both groups. This study provides the strongest evidence to date of an intellectual sparing advantage with PRT in the treatment of pediatric medulloblastoma. (C) 2019 by American Society of Clinical Oncology