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: 8745197
• 负责人: LISA SCHUM KAHALLEY
• 金额: $ 63.65万
• 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 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8745197
• 关键词: Affect; Age; Attention; Brain Neoplasms; Cancer Center; Cancer Patient; Child; Childhood; Childhood Brain Neoplasm; Clinical; Cognitive; Commit; Country; Cranial Irradiation; Data; Decision Making; Deposition; Dose; Environment; Exhibits; Family; Family Physicians; Fostering; Funding; Impaired cognition; Intervention; Late Effects; Literature; Long-Term Survivors; Malignant Neoplasms; Medical; Neurocognitive; Operative Surgical Procedures; Outcome; Patients; Pediatric Hospitals; Photons; Population; Process; Proton Radiation; Publishing; Quality of life; Radiation; Radiation therapy; Reporting; Research; Research Infrastructure; Risk; Risk Factors; 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; oncology program; patient oriented; processing speed; prospective; proton beam; proton therapy; public health relevance; social; survivorship; treatment effect

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）：大多数在美国接受癌症治疗的儿童将实现长期生存，而生存期为这一不断增长的人群带来了独特的挑战。脑肿瘤幸存者尤其面临一系列功能障碍的风险，包括认知，教育，社会和医学障碍。颅放射疗法（RT）仍然是必不可少的救生治疗方法，但显着增加了儿科脑肿瘤患者认知障碍的风险。质子束辐射疗法（PBRT）是小儿脑肿瘤治疗中最有希望的进步之一。 PBRT的拟议医疗优势在于可以用质子束进行辐射递送的精度，将最大剂量沉积到临床靶标，同时最大程度地减少对周围组织的辐射。通过消除对周围健康脑组织的不必要的辐射，可以认为PBRT可以比常规光子或X射线照射（XRT）更好地避免认知功能。但是，迄今为止，还没有证明PBRT与XRT的神经保护益处的经验数据。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，严重性和功能影响。研究1是对单独使用PBRT与手术治疗的小儿脑肿瘤患者中神经认知结局的前瞻性，纵向检查，其特定目的是：（1）检查PBRT后时间随时间的神经认知变化，（2）以治疗类型比较时间（PBRT vs. vs. vs.）。 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.这些研究将在得克萨斯州儿童医院进行，该医院是该国最大的儿科神经肿瘤学计划之一，并且可以使用美国仅11个质子治疗中心中的1个治疗小儿脑肿瘤。该提案与NCI致力于“改善癌症患者，幸存者和家庭的生活质量”的承诺，以促进“安全，以患者为中心，有效，高效和公平”和“基于知情决策促进患者选择”的优质癌症护理。”神经认知的晚期影响极大地影响了许多小儿脑肿瘤幸存者的生活质量和功能独立性。因此，需要研究以确定哪些治疗方法最能限制与后RT神经认知下降相关的痛苦。我们的结果将具有临床价值，提供了及时的关于神经认知功能的报告，并在治疗之间进行了比较，这将指导临床医生在PBRT之后期望的结果范围内。