Long-Term Neurocognitive and Psychological Outcomes in Meningioma Survivors: Individual Changes Over Time and Radiation Dosimetry

IF 2.4 Q2 CLINICAL NEUROLOGY Neuro-oncology practice Pub Date : 2023-11-05 DOI:10.1093/nop/npad072
Angela Sekely, Konstantine K Zakzanis, Donald Mabbott, Derek S Tsang, Paul Kongkham, Gelareh Zadeh, Kim Edelstein
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Abstract

Abstract Background This study investigates long-term changes in neurocognitive performance and psychological symptoms in meningioma survivors, and associations with radiation dose to circumscribed brain regions. Methods We undertook a retrospective study of meningioma survivors who underwent longitudinal clinical neurocognitive assessments. Change in neurocognitive performance or psychological symptoms was assessed using reliable change indices. Radiation dosimetry, if prescribed, was evaluated based on treatment-planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Mixed effects analyses were used to explore whether incidental radiation to brain regions outside the tumor influence neurocognitive and psychological outcomes. Results Most (range=41-93%) survivors demonstrated stable – albeit often below average - neurocognitive and psychological trajectories, although some also exhibited improvements (range=0-31%) or declines (range=0-36%) over time. Higher radiation dose to the parietal-occipital region (partial R2=0.462) and cerebellum (partial R2=0.276) was independently associated with slower visuomotor processing speed. Higher dose to the hippocampi was associated with increases in depression (partial R2=0.367) and trait anxiety (partial R2=0.236). Conclusions Meningioma survivors experience neurocognitive deficits and psychological symptoms many years after diagnosis, and a proportion of them decline over time. This study offers proof of concept that incidental radiation to brain regions beyond the tumor site may contribute to these sequelae. Future investigations should include radiation dosimetry when examining risk factors that contribute to quality of survivorship in this growing population.
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脑膜瘤幸存者的长期神经认知和心理结果:随时间和放射剂量的个体变化
背景本研究探讨脑膜瘤幸存者神经认知表现和心理症状的长期变化及其与限定脑区辐射剂量的关系。方法:我们对接受纵向临床神经认知评估的脑膜瘤幸存者进行回顾性研究。使用可靠的变化指数评估神经认知表现或心理症状的变化。如果有处方,则根据治疗计划的计算机断层扫描与对比增强的3D t1加权磁共振成像共同注册来评估辐射剂量。混合效应分析用于探讨肿瘤外脑区偶发辐射是否会影响神经认知和心理结果。大多数(范围=41-93%)幸存者表现出稳定的神经认知和心理轨迹,尽管通常低于平均水平,尽管一些人也表现出改善(范围=0-31%)或下降(范围=0-36%)随着时间的推移。顶枕区(部分R2=0.462)和小脑(部分R2=0.276)较高的辐射剂量与视觉运动加工速度较慢独立相关。高剂量海马与抑郁(偏R2=0.367)和特质焦虑(偏R2=0.236)增加相关。结论脑膜瘤幸存者在诊断多年后出现神经认知缺陷和心理症状,并且随着时间的推移,这些症状的比例下降。这项研究提供了一个概念的证据,即偶然辐射到肿瘤部位以外的大脑区域可能会导致这些后遗症。在这一不断增长的人群中,未来的调查应包括辐射剂量学,以检查影响生存质量的危险因素。
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来源期刊
Neuro-oncology practice
Neuro-oncology practice CLINICAL NEUROLOGY-
CiteScore
5.30
自引率
11.10%
发文量
92
期刊介绍: Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice. These include: Applying new trial results to improve standards of patient care Translating scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies Raising awareness of basic, translational and clinical research in areas of symptom management, survivorship, neurocognitive function, end of life issues and caregiving
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