Risks of young age for selected neurocognitive deficits in medulloblastoma are associated with white matter loss
Risks of young age for selected neurocognitive deficits in medulloblastoma are associated with white matter loss
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DOI：
10.1200/jco.2001.19.2.472
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发表时间：
2001-01-15
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：验证儿童髓母细胞瘤幸存者年轻时接受颅脊髓照射（CRT）与神经认知功能缺陷之间的关系是否与正常白质（NAWM）发育不足有关。患者和方法：42例自1985年以来接受治疗的患者参与了这项横断面研究。所有患者均接受CRT治疗，伴或不伴化疗，治疗后存活1年以上。通过智力（智商）、言语记忆和持续注意力测试进行神经认知评估。定量磁共振成像采用ct混合神经网络评估NAWM的体积。结果：神经认知测试结果低于测试时年龄的正常预期。年龄越小，在除语言记忆外的所有神经认知测试中表现越差。完成CRT的时间增加与所有神经认知测试的较差表现显著相关，但持续注意力除外。在统计控制了CRT时间的影响后，我们检查了NAWM与神经认知测试结果的关系。这些分析表明，MAWM在CRT年龄与智商、事实知识、语言和非语言思维之间的关联中占有重要地位，但在持续注意力或语言记忆方面没有作用。结论：目前的结果表明，至少在某些认知功能方面，CRT后NAWM发育不足和/或丧失可能为CRT时年轻的不利影响提供了神经解剖学基础。中华临床杂志（19）：472-479。(C) 2001年美国临床肿瘤学会。
Purpose: To test the hypothesis that inadequate development of normal-appearing white matter (NAWM) is associated with the relationship between young age at the time of craniospinal irradiation (CRT) and deficient neurocognitive performance in survivors of childhood medulloblastoma.Patients and Methods: Forty-two patients treated since 1985 participated in this cross-sectional study. All had been treated with CRT with or without chemotherapy and had survived 1 or more years after treatment. Neurocognitive evaluations were conducted with tests of intellect (intelligent quotient; IQ), verbal memory, and sustained attention. Quantitative magnetic resonance imaging, using ct hybrid neural network, assessed the volume of NAWM.Results: Neurocognitive test results were below normal expectations for age at the time of testing. A young age at CRT was significantly associated with worse performance on all neurocognitive tests except that of verbal memory. An increased time from completion of CRT was significantly associated with worse performance on all neurocognitive tests except that of sustained attention, After statistically controlling for the effects of rime from CRT, we examined the association of NAWM with neurocognitive test results. These analyses revealed that MAWM accounted for a significant amount of the association between age at CRT and IQ, factual knowledge, and verbal and nonverbal thinking, but not sustained attention or verbal memory.Conclusion: The present results suggest that, at least for some cognitive functions, deficient development and/or loss of NAWM after CRT may provide a neuroanatomical substrate for the adverse impact of a young age at the time of CRT. J Clin Oncol 19:472-479. (C) 2001 by American Society of Clinical Oncology.