Neurocognitive impairment following proton therapy for paediatric brain tumour: a systematic review of post-therapy asse
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ORIGINAL ARTICLE
Neurocognitive impairment following proton therapy for paediatric brain tumour: a systematic review of post-therapy assessments Noorazrul Yahya 1
&
Hanani Abdul Manan 2
Received: 31 March 2020 / Accepted: 30 September 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Background Proton therapy (PT), frequently utilised to treat paediatric brain tumour (PBT) patients, eliminates exit dose and minimises dose to healthy tissues that theoretically can mitigate treatment-related effects including cognitive deficits. As clinical outcome data are emerging, we aimed to systematically review current evidence of cognitive changes following PT of PBT. Materials and methods We searched PubMed and Scopus electronic databases to identify eligible reports on cognitive changes following PT of PBT according to PRISMA guidelines. Reports were extracted for information on demographics and cognitive outcomes. Then, they were systematically reviewed based on three themes: (1) comparison with photon therapy, (2) comparison with baseline cognitive measures, to population normative mean or radiotherapy-naïve PBT patients and (3) effects of dose distribution to cognition. Results Thirteen reports (median size (range): 70 (12–144)) were included. Four reports compared the cognitive outcome between PBT patients treated with proton to photon therapy and nine compared with baseline/normative mean/radiotherapy naïve from which two reported the effects of dose distribution. Reports found significantly poorer cognitive outcome among patients treated with photon therapy compared with proton therapy especially in general cognition and working memory. Craniospinal irradiation (CSI) was consistently associated with poorer cognitive outcome while focal therapy was associated with minor cognitive change/difference. In limited reports available, higher doses to the hippocampus and temporal lobes were implicated to larger cognitive change. Conclusion Available evidence suggests that PT causes less cognitive deficits compared with photon therapy. Children who underwent focal therapy with proton were consistently shown to have low risk of cognitive deficit suggesting the need for future studies to separate them from CSI. Evidence on the effect of dose distribution to cognition in PT is yet to mature. Keywords Cognition . Paediatric cancers . Brain tumours . Proton therapy
Abbreviations PT Proton therapy PBT Paediatric brain tumour Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00520-020-05808-z) contains supplementary material, which is available to authorized users. * Noorazrul Yahya [email protected] 1
Diagnostic Imaging and Radiotherapy, CODTIS, Faculty of Health Sciences, National University of Malaysia, Jalan Raja Muda Aziz, 50300 Kuala Lumpur, Malaysia
2
Functional Image Processing Laboratory, Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Cheras, 56000 Kuala Lumpur, Malaysia
PRISMA CSI WISC
Preferred Reporting Items for Sy
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