Hippocampal dose volume histogram predicts Hopkins Verbal Learning Test scores after brain irradiation.
Hippocampal dose volume histogram predicts Hopkins Verbal Learning Test scores after brain irradiation.
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DOI：
10.1016/j.adro.2017.08.013
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发表时间：
2017-10
影响因子：
2.3
通讯作者：
Chan MD
中科院分区：
文献类型：
--
作者：
Okoukoni C;McTyre ER;Ayala Peacock DN;Peiffer AM;Strowd R;Cramer C;Hinson WH;Rapp S;Metheny-Barlow L;Shaw EG;Chan MD
原发性和转移性脑肿瘤治疗后，辐射诱导的认知功能下降相对常见;然而，由于患者特征的异质性，很难确定预测辐射诱导的认知功能下降的剂量学参数。记忆功能在治疗后特别容易受到辐射影响。本研究的目的是将关键神经解剖结构接受的体积辐射剂量与放射治疗（RT）后记忆障碍相关联。2008年至2011年，53例原发性脑恶性肿瘤患者在我们机构进行的前瞻性累积临床试验中接受了常规分割RT治疗。对海马、海马旁、杏仁核和梭状回进行剂量-体积直方图分析。霍普金斯言语学习测试-修订版评分在RT后至少6个月获得。损伤定义为即时回忆评分≤ 15。对于每个解剖区域，进行系列回归，以将接受给定剂量（VD（戈伊））的体积与记忆障碍相关联。海马V53.4Gy~V60.9Gy显著预测RT后记忆损害（P <0.05）。在此范围内，海马V55 Gy是最显著的预测因子（P =.004）。0%、25%和50%的海马V55 Gy分别与14.9%（95%置信区间[CI]，7.2%-28.7%）、45.9%（95% CI，24.7%-68.6%）和80.6%（95% CI，39.2%-96.4%）的肿瘤诱导损伤率相关。海马V55戈伊是损伤的重要预测因子，低于55戈伊的限制剂量可使辐射诱导的认知损伤最小化。
Radiation-induced cognitive decline is relatively common after treatment for primary and metastatic brain tumors; however, identifying dosimetric parameters that are predictive of radiation-induced cognitive decline is difficult due to the heterogeneity of patient characteristics. The memory function is especially susceptible to radiation effects after treatment. The objective of this study is to correlate volumetric radiation doses received by critical neuroanatomic structures to post–radiation therapy (RT) memory impairment. Between 2008 and 2011, 53 patients with primary brain malignancies were treated with conventionally fractionated RT in prospectively accrued clinical trials performed at our institution. Dose-volume histogram analysis was performed for the hippocampus, parahippocampus, amygdala, and fusiform gyrus. Hopkins Verbal Learning Test-Revised scores were obtained at least 6 months after RT. Impairment was defined as an immediate recall score ≤15. For each anatomic region, serial regression was performed to correlate volume receiving a given dose (VD(Gy)) with memory impairment. Hippocampal V53.4Gy to V60.9Gy significantly predicted post-RT memory impairment (P < .05). Within this range, the hippocampal V55Gy was the most significant predictor (P = .004). Hippocampal V55Gy of 0%, 25%, and 50% was associated with tumor-induced impairment rates of 14.9% (95% confidence interval [CI], 7.2%-28.7%), 45.9% (95% CI, 24.7%-68.6%), and 80.6% (95% CI, 39.2%-96.4%), respectively. The hippocampal V55Gy is a significant predictor for impairment, and a limiting dose below 55 Gy may minimize radiation-induced cognitive impairment.