Proton Therapy Mediates Dose Reductions to Brain Structures Associated with Cognition in Children with Medulloblastoma.
cognition
medulloblastoma
proton therapy
radiotherapy
Journal
International journal of radiation oncology, biology, physics
ISSN: 1879-355X
Titre abrégé: Int J Radiat Oncol Biol Phys
Pays: United States
ID NLM: 7603616
Informations de publication
Date de publication:
29 Nov 2023
29 Nov 2023
Historique:
received:
17
07
2023
revised:
27
10
2023
accepted:
19
11
2023
medline:
2
12
2023
pubmed:
2
12
2023
entrez:
1
12
2023
Statut:
aheadofprint
Résumé
Emerging evidence suggests proton radiotherapy may offer cognitive sparing advantages over photon radiotherapy, yet dosimetry has not been compared previously. The purpose of this study is to examine dosimetric correlates of cognitive outcomes in children with medulloblastoma treated with proton vs. photon radiotherapy. In this retrospective, bi-institutional study, dosimetric and cognitive data from 75 patients (39 photon and 36 proton) were analyzed. Doses to brain structures were compared between treatment modalities. Linear mixed effects models were used to create models of global IQ and cognitive domain scores. The mean dose and dose to 40% of the brain (D40) were 2.7 and 4.1 Gy less among proton-treated patients as compared to photon-treated patients (p = 0.03 and 0.007, respectively). Mean doses to the left and right hippocampi were 11.2 Gy lower among proton-treated patients (p < 0.001 for both). Mean doses to the left and right temporal lobes were 6.9 and 7.1 Gy lower with proton treatment, respectively (p < 0.001 for both). Models of cognition found statistically significant associations between higher mean brain dose and reduced verbal comprehension, increased right temporal lobe D40 with reduced perceptual reasoning, and greater left temporal mean dose with reduced working memory. Higher brain D40 was associated with reduced processing speed and global IQ scores. Proton therapy reduces doses to normal brain structures as compared with photon treatment. This leads to reduced cognitive decline post-RT across multiple intellectual endpoints. Proton therapy should be offered to children receiving radiation for medulloblastoma.
Sections du résumé
BACKGROUND
BACKGROUND
Emerging evidence suggests proton radiotherapy may offer cognitive sparing advantages over photon radiotherapy, yet dosimetry has not been compared previously. The purpose of this study is to examine dosimetric correlates of cognitive outcomes in children with medulloblastoma treated with proton vs. photon radiotherapy.
METHODS
METHODS
In this retrospective, bi-institutional study, dosimetric and cognitive data from 75 patients (39 photon and 36 proton) were analyzed. Doses to brain structures were compared between treatment modalities. Linear mixed effects models were used to create models of global IQ and cognitive domain scores.
RESULTS
RESULTS
The mean dose and dose to 40% of the brain (D40) were 2.7 and 4.1 Gy less among proton-treated patients as compared to photon-treated patients (p = 0.03 and 0.007, respectively). Mean doses to the left and right hippocampi were 11.2 Gy lower among proton-treated patients (p < 0.001 for both). Mean doses to the left and right temporal lobes were 6.9 and 7.1 Gy lower with proton treatment, respectively (p < 0.001 for both). Models of cognition found statistically significant associations between higher mean brain dose and reduced verbal comprehension, increased right temporal lobe D40 with reduced perceptual reasoning, and greater left temporal mean dose with reduced working memory. Higher brain D40 was associated with reduced processing speed and global IQ scores.
CONCLUSIONS
CONCLUSIONS
Proton therapy reduces doses to normal brain structures as compared with photon treatment. This leads to reduced cognitive decline post-RT across multiple intellectual endpoints. Proton therapy should be offered to children receiving radiation for medulloblastoma.
Identifiants
pubmed: 38040059
pii: S0360-3016(23)08164-6
doi: 10.1016/j.ijrobp.2023.11.035
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NCI NIH HHS
ID : K07 CA157923
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA187202
Pays : United States
Organisme : NCI NIH HHS
ID : R01 CA249988
Pays : United States
Informations de copyright
Copyright © 2023. Published by Elsevier Inc.