Neurocognitive consequences of risk-adapted therapy for childhood medulloblastorna
Neurocognitive consequences of risk-adapted therapy for childhood medulloblastorna
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DOI：
10.1200/jco.2005.00.703
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发表时间：
2005-08-20
影响因子：
45.3
通讯作者：
Gajjar, A
中科院分区：
文献类型：
--
作者：
Mulhern, RK;Palmer, SL;Gajjar, A
目的 这项前瞻性纵向研究探讨了风险适应颅脊髓照射 (CSI) 剂量的影响，以及剂量与年龄和诊断时间之间的相互作用，对接受髓母细胞瘤 (MB) 治疗的患者的智商 (IQ) 和学业成绩（阅读、拼写和数学）的影响。 患者和方法 患者在诊断后 0 至 6.03 年（中位时间为 3.14 年）内接受了一系列神经认知测试。这项多机构研究包括 111 名患者，诊断时年龄为 3 至 20 岁（中位年龄为 7.4 岁），接受风险适应 CSI 的 IMB 治疗，然后进行四个周期的高剂量化疗（环磷酰胺、顺铂和长春新碱）和干细胞支持。高危患者（HR；n = 37）接受 CSI 至 36 至 39.6 Gy，并对原发部位进行适形加强治疗至 55.8 至 59.4 Gy。平均风险患者（AR；In = 74）接受 CSI 至 23.4 Gy，后颅窝适形加强治疗至 36.0 Gy，原发部位至 55.8 Gy。结果 多变量模型显示平均 IQ 显着下降（-1.59 点/年；P = .006）、读数（-2.95 点/年；P）
Purpose This prospective, longitudinal study examined the effects of risk-adapted craniospinal irradiation (CSI) dose and the interactions of dose with age and time from diagnosis on intelligence quotient (IQ) and academic achievement (reading, spelling, and math) among patients treated for medulloblastoma (MB).Patients and Methods Patients received serial neurocognitive testing spanning from 0 to 6.03 years after diagnosis (median, 3.14 years). The multi-institutional study included 111 patients, who were 3 to 20 years of age at diagnosis (median age, 7.4 years), treated for IMB with risk-adapted CSI followed by four cycles of high-dose chemotherapy (cyclophosphamide, cisplatin, and vincristine) with stem-cell support. High-risk patients (HR; n = 37) received CSI to 36 to 39.6 Gy and conformal boost treatment of the primary site to 55.8 to 59.4 Gy. Average-risk patients (AR; In = 74) received CSI to 23.4 Gy and conformal boost treatment of the posterior fossa to 36.0 Gy and primary site to 55.8 Gy.Results Multivariate modeling revealed statistically significant declines in mean IQ (-1.59 points/yr; P =.006), reading (-2.95 points/yr; P