Risk factors for domain-specific neurocognitive outcome in pediatric survivors of a brain tumor in the posterior fossa-Results of the HIT 2000 trial.

IF 16.4 1区 医学 Q1 CLINICAL NEUROLOGY
Martin Mynarek, Anne Rossius, Anika Guiard, Holger Ottensmeier, Katja von Hoff, Denise Obrecht-Sturm, Lisa Bußenius, Carsten Friedrich, Andre O von Bueren, Nicolas U Gerber, Thomas Traunwieser, Rolf-Dieter Kortmann, Monika Warmuth-Metz, Brigitte Bison, Ulrich-W Thomale, Juergen Krauss, Torsten Pietsch, Steven C Clifford, Stefan M Pfister, Dominik Sturm, Felix Sahm, Tanja Tischler, Stefan Rutkowski
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引用次数: 0

Abstract

Background: Neurocognition can be severely affected in pediatric brain tumor survivors. We analyzed the association of cognitive functioning with radiotherapy dose, postoperative cerebellar mutism syndrome (pCMS), hydrocephalus, intraventricular methotrexate (MTX) application, tumor localization, and biology in pediatric survivors of a posterior fossa tumor.

Methods: Subdomain-specific neurocognitive outcome data from 279 relapse-free survivors of the HIT-2000 trial (241 medulloblastoma and 38 infratentorial ependymoma) using the Neuropsychological Basic Diagnostic tool based on Cattell-Horn-Carroll's model for intelligence were analyzed.

Results: Cognitive performance 5.14 years (mean; range = 1.52-13.02) after diagnosis was significantly below normal for all subtests. Processing speed and psychomotor abilities were most affected. Influencing factors were domain-specific: CSI-dose had a strong impact on most subtests. pCMS was associated with psychomotor abilities (β = -0.25 to -0.16) and processing speed (β = -0.32). Postoperative hydrocephalus correlated with crystallized intelligence (β = -0.20) and short-term memory (β = -0.15), age with crystallized intelligence (β = 0.15) and psychomotor abilities (β = -0.16 and β = -0.17). Scores for fluid intelligence (β = -0.23), short-term memory (β = -0.17) and visual processing (β = -0.25) declined, and scores for selective attention improved (β = 0.29) with time after diagnosis.

Conclusions: The dose of CSI was strongly associated with neurocognitive outcomes. Low psychomotor abilities and processing speed both in patients treated with and without CSI suggest a strong contribution of the tumor and its surgery on these functions. Future research therefore should analyze strategies to both reduce CSI dose and toxicity caused by other treatment modalities.

后窝脑肿瘤儿科幸存者特定领域神经认知结果的风险因素 - HIT 2000 试验结果。
背景:小儿脑肿瘤幸存者的神经认知可能会受到严重影响。我们分析了小儿后窝肿瘤幸存者的认知功能与放疗剂量、术后小脑缄默综合征(pCMS)、脑积水、脑室内甲氨蝶呤(MTX)应用、肿瘤定位和生物学的关系:方法:使用基于卡泰尔-霍恩-卡罗尔智力模型的神经心理学基础诊断(NBD)工具,对HIT-2000试验的279名无复发幸存者(241名髓母细胞瘤患者和38名幕后下胚状体上皮瘤患者)的神经认知结果数据进行分析:结果:确诊后5.14年(平均值;范围=1.52-13.02)的认知表现在所有子测试中均明显低于正常水平。处理速度和精神运动能力受影响最大。影响因素因领域而异:pCMS 与精神运动能力(β=-0.25 至-0.16)和处理速度(β=-0.32)相关。术后脑积水与智能晶体(β=-0.20)和短期记忆(β=-0.15)相关,年龄与智能晶体(β=0.15)和精神运动能力(β=-0.16 和 β=-0.17)相关。流体智能(β=-0.23)、短时记忆(β=-0.17)和视觉处理(β=-0.25)的得分随着诊断后时间的推移而下降,而选择性注意的得分随着诊断后时间的推移而提高(β=0.29):结论:CSI剂量与神经认知结果密切相关。结论:CSI剂量与神经认知结果密切相关。接受和未接受CSI治疗的患者的精神运动能力和处理速度均较低,这表明肿瘤及其手术对这些功能的影响很大。因此,未来的研究应分析减少CSI剂量和其他治疗方式引起的毒性的策略。
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来源期刊
Neuro-oncology
Neuro-oncology 医学-临床神经学
CiteScore
27.20
自引率
6.30%
发文量
1434
审稿时长
3-8 weeks
期刊介绍: Neuro-Oncology, the official journal of the Society for Neuro-Oncology, has been published monthly since January 2010. Affiliated with the Japan Society for Neuro-Oncology and the European Association of Neuro-Oncology, it is a global leader in the field. The journal is committed to swiftly disseminating high-quality information across all areas of neuro-oncology. It features peer-reviewed articles, reviews, symposia on various topics, abstracts from annual meetings, and updates from neuro-oncology societies worldwide.
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