Predicting the risk of neurocognitive decline after brain irradiation in adult patients with a primary brain tumor.
Neuro Oncol
; 26(8): 1467-1478, 2024 Aug 05.
Article
em En
| MEDLINE
| ID: mdl-38595122
ABSTRACT
BACKGROUND:
Deterioration of neurocognitive function in adult patients with a primary brain tumor is the most concerning side effect of radiotherapy. This study aimed to develop and evaluate normal-tissue complication probability (NTCP) models using clinical and dose-volume measures for 6-month, 1-year, and 2-year Neurocognitive Decline (ND) postradiotherapy.METHODS:
A total of 219 patients with a primary brain tumor treated with radical photon and/or proton radiotherapy (RT) between 2019 and 2022 were included. Controlled oral word association test, Hopkins verbal learning test-revised, and trail making test were used to objectively measure ND. A comprehensive set of potential clinical and dose-volume measures on several brain structures were considered for statistical modeling. Clinical, dose-volume and combined models were constructed and internally tested in terms of discrimination (area under the curve, AUC), calibration (mean absolute error, MAE), and net benefit.RESULTS:
Fifty percent, 44.5%, and 42.7% of the patients developed ND at 6-month, 1-year, and 2-year time points, respectively. The following predictors were included in the combined model for 6-month ND age at radiotherapyâ >â 56 years (ORâ =â 5.71), overweight (ORâ =â 0.49), obesity (ORâ =â 0.35), chemotherapy (ORâ =â 2.23), brain V20 Gyâ ≥â 20% (ORâ =â 3.53), brainstem volumeâ ≥â 26 cc (ORâ =â 0.39), and hypothalamus volumeâ ≥â 0.5 cc (ORâ =â 0.4). Decision curve analysis showed that the combined models had the highest net benefits at 6-month (AUCâ =â 0.79, MAEâ =â 0.021), 1-year (AUCâ =â 0.72, MAEâ =â 0.027), and 2-year (AUCâ =â 0.69, MAEâ =â 0.038) time points.CONCLUSIONS:
The proposed NTCP models use easy-to-obtain predictors to identify patients at high risk of ND after brain RT. These models can potentially provide a base for RT-related decisions and post-therapy neurocognitive rehabilitation interventions.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Neoplasias Encefálicas
/
Irradiação Craniana
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article