Radiotherapy-induced neurocognitive decline among adult intracranial tumor patients: A voxel-based approach

作者：Charlotte Sleurs, Catharina M.L. Zegers, Marvin Ribeiro, Wouter van Elmpt, Jeanette Dijkstra, Alida A. Postma, Laurien De Roeck, Karin Gehring, Wouter De Baene, Margriet M. Sitskoorn, Maarten Lambrecht, Daniëlle B. P. Eekers · 发表于：Neuro-Oncology · 年份：2025 · DOI：10.1093/neuonc/noaf114 · 被引用次数：3 · 研究领域：Brain Metastases and Treatment、Glioma Diagnosis and Treatment、Cancer-related cognitive impairment studies

BACKGROUND: Cranial irradiation is a key component of neuro-oncological treatment but can result in cognitive side effects. Preserving cognition from radiotherapy-(RT)-induced toxicity remains an ongoing debate. To spatially map radiotoxic effects in patients who underwent cranial RT, this study applied a voxel-based approach. METHODS: Cognitive assessments (Controlled Word Association (COWA), Hopkins Verbal Learning (HVLT-R), and Trail Making Tests (TMT A,B)) were conducted prospectively before, 6 months and 1 year post-RT in 111 intracranial tumor patients (18-80 years). Reliable change indices indicated cognitive changes across timepoints. CT and T1-weighted MRI scans acquired at diagnosis were co-registered, normalized to standard space, and smoothed. Voxel-wise permutation-based regression analyses examined the relationship between RT dose and cognitive decline (α < 0.05 at cluster level). RESULTS: Images of 111 patients (Mdn age = 55.39 years; 47% male; lesions were gliomas (61%), meningiomas (18%), other (21%); in frontal (33%), temporal (25%), other location (42%)) were analyzed. Reliable decline was most pronounced at 6 months, particularly on the TMT A (25.77%), TMT B (24.21%), and HVLT immediate recall (21%). At 1 year, 20% of patients continued to show a decline in TMT B. Higher RT doses to frontal gyri, temporal, occipital, and para-central regions were associated with declines in verbal fluency, memory, processing speed, and flexibility at both peak- and cluster...