Cognitive Change after Proton RT vs. Photon or Surgery for Pediatric Brain Tumor

质子放疗与光子放疗或手术治疗小儿脑肿瘤后的认知变化

• 批准号: 9334130
• 负责人: LISA SCHUM KAHALLEY
• 金额: $ 57.7万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-18 至 2020-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9334130
• 关键词: Affect; Age; Attention; Brain Neoplasms; Cancer Center; Cancer Patient; Child; Childhood; Childhood Brain Neoplasm; Clinical; Cognitive; Country; Cranial Irradiation; Data; Decision Making; Deposition; Dose; Environment; Exhibits; Family; Fostering; Funding; Impaired cognition; Intervention; Late Effects; Literature; Long-Term Survivors; Malignant Neoplasms; Medical; Neurocognitive; Neurocognitive Deficit; Operative Surgical Procedures; Outcome; Patient-Focused Outcomes; Patients; Pediatric Hospitals; Pediatric Surgical Procedures; Photons; Physicians; Population; Process; Proton Radiation; Publishing; Quality of life; Radiation; Radiation therapy; Recruitment Activity; Reporting; Research; Research Infrastructure; Risk; Risk Factors; Roentgen Rays; Severities; Short-Term Memory; Survivors; Technology; Testing; Texas; Time; Tissues; Toxic effect; base; brain tissue; brain volume; cancer care; clinical care; clinical risk; cognitive change; cognitive function; cohort; comparison group; cost; disability; disorder control; experience; follow-up; functional disability; functional outcomes; improved; interest; irradiation; multidisciplinary; neuro-oncology; neurobehavioral; neurocognitive test; patient oriented; processing speed; programs; prospective; proton beam; proton therapy; public health relevance; social; survivorship; treatment effect; treatment group

DESCRIPTION (provided by applicant): Most children treated for cancer in the US will achieve long-term survival, and survivorship presents unique challenges for this growing population. Brain tumor survivors are at particular risk for a range of functional impairments, including cognitive, educational, social, and medical disabilities. Cranial radiation therapy (RT) remains an essential lifesaving treatment but significantly increases the risk of cognitive impairment for pediatric brain tumor patients. Proton beam radiation therapy (PBRT) is one of the most promising advances in pediatric brain tumor treatment. The proposed medical advantage of PBRT lies in the precision of radiation delivery possible with proton beams, depositing maximum dose to clinical targets while minimizing radiation to surrounding tissues. By eliminating unnecessary radiation to surrounding healthy brain tissue, it is believed that PBRT may spare cognitive functioning better than conventional photon or x-ray irradiation (XRT). However, to date, there is no empirical data documenting the neuroprotective benefits of PBRT over XRT. We will assess the quality, severity, and functional impact of neurocognitive changes following PBRT in pediatric brain tumor patients and survivors. Study 1 is a prospective, longitudinal examination of neurocognitive outcomes among pediatric brain tumor patients treated with PBRT versus surgery alone with the following specific aims: (1) to examine neurocognitive change over time following PBRT, and (2) to compare neurocognitive change over time by treatment type (PBRT vs. Surgery Only). Study 2 is a longitudinal comparison of neurocognitive outcomes between long-term survivors of pediatric brain tumors treated with PBRT versus XRT with the following specific aims: (1) to examine neurocognitive change over time following RT, (2) to compare neurocognitive change over time by treatment type (PBRT vs. XRT), and (3) to identify clinical risk factors associated with neurocognitive decline following treatment. These studies will be conducted at Texas Children's Hospital, which has one of the largest pediatric neuro-oncology programs in the country and access to 1 of only 11 proton therapy centers in the US treating pediatric brain tumors. This proposal is consistent with NCI's commitment to "improve the quality of life for cancer patients, survivors, and families," to promote quality cancer care that is "safe, patient-centered, effective.timely, efficient, and equitable," and to "foster patient choice based on informed decision making." Neurocognitive late effects greatly affect the long-term quality of life and functional independence of many pediatric brain tumor survivors. Thus, research is needed to determine which treatments are best able to limit suffering associated with post-RT neurocognitive decline. Our results will have clinical value, providing a timely report of neurocognitive functioning and comparison between treatments that will guide clinicians on the range of outcomes to expect after PBRT.

描述（由申请人提供）：在美国，大多数接受癌症治疗的儿童都将实现长期生存，而生存对这一不断增长的人口提出了独特的挑战。脑肿瘤幸存者面临一系列功能障碍的特别风险，包括认知、教育、社交和医疗障碍。颅脑放射治疗（RT）仍然是一种重要的救生治疗方法，但会显着增加儿童脑肿瘤患者认知障碍的风险。质子束放射治疗（PBRT）是儿科脑肿瘤治疗中最有前途的进展之一。 PBRT 的医疗优势在于质子束可以实现精确的放射治疗，向临床靶标提供最大剂量，同时最大限度地减少对周围组织的辐射。通过消除对周围健康脑组织不必要的辐射，人们相信 PBRT 可以比传统光子或 X 射线照射 (XRT) 更好地保护认知功能。然而，迄今为止，尚无经验数据证明 PBRT 相对 XRT 的神经保护益处。我们将评估儿科脑肿瘤患者和幸存者 PBRT 后神经认知变化的质量、严重程度和功能影响。研究 1 是对接受 PBRT 治疗与单独手术治疗的儿童脑肿瘤患者的神经认知结果进行前瞻性、纵向检查，其具体目的如下：(1) 检查 PBRT 后随时间的神经认知变化，以及 (2) 比较不同治疗类型随时间的神经认知变化（PBRT 与仅手术）。研究 2 是对接受 PBRT 与 XRT 治疗的儿童脑肿瘤长期幸存者之间的神经认知结果进行纵向比较，其具体目的如下：(1) 检查 RT 后神经认知随时间的变化，(2) 比较不同治疗类型（PBRT 与 XRT）随时间的神经认知变化，以及 (3) 确定与治疗后神经认知衰退相关的临床危险因素。这些研究将在德克萨斯儿童医院进行，该医院拥有美国最大的儿科神经肿瘤项目之一，并且可以使用美国仅有的 11 个治疗儿科脑肿瘤的质子治疗中心之一。该提案符合 NCI 的承诺，即“提高癌症患者、幸存者和家庭的生活质量”，促进“安全、以患者为中心、有效、及时、高效和公平”的优质癌症护理，以及“促进患者基于知情决策的选择”。神经认知迟发效应极大地影响了许多儿科脑肿瘤幸存者的长期生活质量和功能独立性。因此，需要进行研究来确定哪些治疗方法最能限制与放疗后神经认知衰退相关的痛苦。我们的结果将具有临床价值，及时提供神经认知功能报告以及治疗方法之间的比较，从而指导临床医生了解 PBRT 后预期的结果范围。