Neuroprotective benefits of proton beam therapy for paediatric central nervous system tumours: a review of evidence

Goodridge, Georgia and Kirby, Michael ORCID: 0000-0001-9765-5641 (2023) Neuroprotective benefits of proton beam therapy for paediatric central nervous system tumours: a review of evidence. [Poster]

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Abstract

Introduction Proton beam therapy (PBT) is often used for paediatric central nervous system (CNS) tumours for its potential to reduce neurocognitive effects. This is due to the dosimetric properties of PBT, providing a more conformal dose to the target volume and lower integral dose to healthy tissue compared with photon therapy. This helps lower dose to critical structures in the brain, reduce long-term neurocognitive deficits and potentially improve quality of life (QOL). This literature review aims to examine the neuroprotective benefits of PBT in paediatric patients diagnosed with CNS tumours at the longest possible follow-up to determine if these hypotheses continue to provide comparable QOL to the normative population. Method PubMed and Scopus were systematically searched to identify appropriate studies on neurocognitive late effects following PBT according to PRISMA protocols. Key words were chosen based on PICO criteria with main themes including PBT, paediatric CNS tumours and neurocognitive tests. Results Ten papers were selected and appraised (mean no. of patients(range): 63.1 (18 -114)). All reports included PBT only, with seven including Craniospinal Irradiation (CSI). One exception for photon contingency treatment was accepted. The most common tumour types identified were craniopharyngioma, ependymoma, intracranial germ cell tumour, low- and intermediate-grade gliomas and medulloblastoma. Over half of the studies included baseline assessments. In general, Full Scale Intelligence Quotient (FSIQ) was not observed to differ significantly from the normative population. Deficits at follow-up were often predicted at baseline showing the diagnosis alone could be indicative of poor neurocognitive function. Significantly poorer outcomes were observed following CSI treatment, compared with focal treatment where minor cognitive changes were identified in characteristics such as processing speed and working memory index. Tumour location was identified as a predictor for poor neurological status, with basal ganglia germ cell tumours demonstrating the most deficit compared to other locations. Conclusion Evidence continues to indicate cognitive sparing years after treatment, due to beneficial dosimetric properties of PBT. Patients receiving focal treatment demonstrated a consistently lower risk of cognitive deficits compared to CSI patients; indicating a requirement for separate research directives. Reduced dose to certain cranial structures may be a protector of long-term neurocognitive deficit. Longer-term follow up is required to determine if cognitive risk continues to stay within the limits of the normative population or decreases over time. Neuroprotective benefits of PBT were seen across much of the data, indicating PBT continues to spare cognitive function over time. Key words: Paediatric CNS tumour, Proton beam therapy, Neurocognitive

Item Type:	Poster
Divisions:	Faculty of Health and Life Sciences Faculty of Health and Life Sciences > Institute of Population Health Faculty of Health and Life Sciences > Institute of Population Health > School of Health Sciences
Depositing User:	Symplectic Admin
Date Deposited:	13 Oct 2023 07:37
Last Modified:	13 Oct 2023 07:37
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3173623