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Dynamic Lung Tumor Tracking for Stereotactic Ablative Body Radiation Therapy
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Long-term cognitive dysfunction after radiation therapy for primary brain tumors.

Lene Haldbo-Classen1, Ali Amidi2, Lisa M Wu3

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Acta Oncologica (Stockholm, Sweden)
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Radiation therapy (RT) for brain tumors can negatively impact cognitive functions, particularly processing speed and executive function. Proton RT may offer better brain sparing, potentially reducing cognitive deficits compared to photon RT.

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Area of Science:

  • Neuro-oncology
  • Radiation Oncology
  • Cognitive Neuroscience

Background:

  • The long-term cognitive effects of radiation therapy (RT) for primary brain tumors remain incompletely understood.
  • While proton RT is hypothesized to spare healthy brain tissue better than photon RT, potentially reducing cognitive dysfunction, evidence is limited.
  • Identifying specific cognitive domains most affected by RT is crucial for developing preventative strategies.

Purpose of the Study:

  • To compare cognitive functioning in brain tumor patients treated with neurosurgery and RT versus those treated with neurosurgery alone.
  • To determine which cognitive domains are most significantly impacted by RT in brain tumor patients.

Main Methods:

  • A cross-sectional study involving 110 primary brain tumor patients (grades I-IV) treated between 2006-2016.
  • Two cohorts were analyzed: 81 patients receiving neurosurgery and RT (RT+) and 29 patients receiving neurosurgery alone (RT-).
  • Cognitive function was assessed using questionnaires and standardized neuropsychological tests.

Main Results:

  • The entire patient group showed significantly lower average scores compared to normative data in verbal learning/memory, attention/working memory, processing speed, and executive functioning (p < .001).
  • RT+ patients exhibited lower scores in processing speed (p = .04) and executive function (p = .05) compared to RT- patients.
  • Higher impairment frequency in verbal fluency was observed in the RT+ group (p = .02), with 16% of patients scoring more than 1.5 SD below normative data.

Conclusions:

  • Treatment for primary brain tumors, particularly when including RT, can lead to long-term negative effects on cognitive function.
  • Processing speed and executive functions are identified as particularly vulnerable cognitive domains following RT.
  • Further research into RT techniques, such as proton therapy, is warranted to mitigate cognitive decline in brain tumor survivors.