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Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis

BACKGROUND: Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However, radiation therapy is associated with significant long-term neurocognitive morbidity. The present systematic review and m...

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Autores principales: Lassaletta, Álvaro, Morales, Javier S., Valenzuela, Pedro L., Esteso, Borja, Kahalley, Lisa S., Mabbott, Donald J., Unnikrishnan, Soumya, Panizo, Elena, Calvo, Felipe
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Nature Singapore 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10348930/
https://www.ncbi.nlm.nih.gov/pubmed/37154861
http://dx.doi.org/10.1007/s12519-023-00726-6
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author Lassaletta, Álvaro
Morales, Javier S.
Valenzuela, Pedro L.
Esteso, Borja
Kahalley, Lisa S.
Mabbott, Donald J.
Unnikrishnan, Soumya
Panizo, Elena
Calvo, Felipe
author_facet Lassaletta, Álvaro
Morales, Javier S.
Valenzuela, Pedro L.
Esteso, Borja
Kahalley, Lisa S.
Mabbott, Donald J.
Unnikrishnan, Soumya
Panizo, Elena
Calvo, Felipe
author_sort Lassaletta, Álvaro
collection PubMed
description BACKGROUND: Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However, radiation therapy is associated with significant long-term neurocognitive morbidity. The present systematic review and meta-analysis aimed to compare the neurocognitive outcomes of children and adolescents with brain tumors treated with photon radiation (XRT) or proton therapy (PBRT). METHODS: A systematic search was conducted (PubMed, Embase, Cochrane, and Web of Science from inception until 02/01/2022) for studies comparing the neurocognitive outcomes of children and adolescents with brain tumors treated with XRT vs. PBRT. The pooled mean differences (expressed as Z scores) were calculated using a random effects method for those endpoints analyzed by a minimum of three studies. RESULTS: Totally 10 studies (n = 630 patients, average age range: 1–20 years) met the inclusion criteria. Patients who had received PBRT achieved significantly higher scores (difference in Z scores ranging from 0.29–0.75, all P < 0.05 and significant in sensitivity analyses) after treatment than those who had received XRT for most analyzed neurocognitive outcomes (i.e., intelligence quotient, verbal comprehension and perceptual reasoning indices, visual motor integration, and verbal memory). No robust significant differences (P > 0.05 in main analyses or sensitivity analyses) were found for nonverbal memory, verbal working memory and working memory index, processing speed index, or focused attention. CONCLUSIONS: Pediatric brain tumor patients who receive PBRT achieve significantly higher scores on most neurocognitive outcomes than those who receive XRT. Larger studies with long-term follow-ups are needed to confirm these results. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12519-023-00726-6.
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spelling pubmed-103489302023-07-16 Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis Lassaletta, Álvaro Morales, Javier S. Valenzuela, Pedro L. Esteso, Borja Kahalley, Lisa S. Mabbott, Donald J. Unnikrishnan, Soumya Panizo, Elena Calvo, Felipe World J Pediatr Meta-Analysis BACKGROUND: Advances in cancer treatments, particularly the development of radiation therapy, have led to improvements in survival outcomes in children with brain tumors. However, radiation therapy is associated with significant long-term neurocognitive morbidity. The present systematic review and meta-analysis aimed to compare the neurocognitive outcomes of children and adolescents with brain tumors treated with photon radiation (XRT) or proton therapy (PBRT). METHODS: A systematic search was conducted (PubMed, Embase, Cochrane, and Web of Science from inception until 02/01/2022) for studies comparing the neurocognitive outcomes of children and adolescents with brain tumors treated with XRT vs. PBRT. The pooled mean differences (expressed as Z scores) were calculated using a random effects method for those endpoints analyzed by a minimum of three studies. RESULTS: Totally 10 studies (n = 630 patients, average age range: 1–20 years) met the inclusion criteria. Patients who had received PBRT achieved significantly higher scores (difference in Z scores ranging from 0.29–0.75, all P < 0.05 and significant in sensitivity analyses) after treatment than those who had received XRT for most analyzed neurocognitive outcomes (i.e., intelligence quotient, verbal comprehension and perceptual reasoning indices, visual motor integration, and verbal memory). No robust significant differences (P > 0.05 in main analyses or sensitivity analyses) were found for nonverbal memory, verbal working memory and working memory index, processing speed index, or focused attention. CONCLUSIONS: Pediatric brain tumor patients who receive PBRT achieve significantly higher scores on most neurocognitive outcomes than those who receive XRT. Larger studies with long-term follow-ups are needed to confirm these results. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12519-023-00726-6. Springer Nature Singapore 2023-05-08 2023 /pmc/articles/PMC10348930/ /pubmed/37154861 http://dx.doi.org/10.1007/s12519-023-00726-6 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Meta-Analysis
Lassaletta, Álvaro
Morales, Javier S.
Valenzuela, Pedro L.
Esteso, Borja
Kahalley, Lisa S.
Mabbott, Donald J.
Unnikrishnan, Soumya
Panizo, Elena
Calvo, Felipe
Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis
title Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis
title_full Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis
title_fullStr Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis
title_full_unstemmed Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis
title_short Neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis
title_sort neurocognitive outcomes in pediatric brain tumors after treatment with proton versus photon radiation: a systematic review and meta-analysis
topic Meta-Analysis
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10348930/
https://www.ncbi.nlm.nih.gov/pubmed/37154861
http://dx.doi.org/10.1007/s12519-023-00726-6
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