Brain age lags behind chronological age after proton therapy for pediatric craniopharyngioma

After proton RT for pediatric craniopharyngioma, brain age lagged behind chronological age by a median of 2.78 years at 5 years (βTime -0.25, 95% CI -0.41 to -0.09, p<0.001). More pronounced in younger patients and males. Retrospective, DWI model.

• Retrospective cohort of 90 pediatric craniopharyngioma patients (median age 9.17 years, 54% female) who received 54-Gy proton radiotherapy; brain age estimated from diffusion-weighted imaging fractional anisotropy using a ridge regression model validated on an independent test set (n=18).
• Significant time-by-age interaction (βTime:Age -0.24, 95% CI -0.34 to -0.13, p<0.001) and time-by-sex interaction (βTime:Sex[Male] -0.23, 95% CI -0.42 to -0.05, p=0.016); baseline IGF-1 z-score positively correlated with brain age gap (β=0.27, p=0.027).
• Single-center retrospective study; model not externally validated, limiting generalizability.

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