3. Procedures and Data Analyses
cancer, Cancer
ADVERSE EVENTS, ADVERSE EVENT, CANCER, CANCER
This study was approved by the local Institutional Review Board, and informed written consent was obtained from the subject. The participant is a native English speaker with corrected to normal auditory and visual acuity. Neuropsychological exams, including the Uniform Data Set version 3 (UDS3) neuropsychological battery, were administered to measure cognitive function. The scores were normalized to z-scores for UDS3, with considerations for age, gender, and education, whereas the Rey Auditory Verbal Learning Test (RAVLT) scores were specifically adjusted for age with Mayo’s Older Americans Normative Studies (MOANS) [TMS parameters were established following an evaluation of safety, feasibility, and efficacy. The participant underwent 10 consecutive sessions of iTBS during weekdays over the course of two weeks, ensuring robust and reliable outcomes [MRI sequences, T1-MPRAGE anatomical MRI and resting-state functional MRI (RS-fMRI), were acquired on a Siemens Skyra 3 Tesla MRI scanner (Siemens Medical Systems, Erlangen, Germany) with a 32-channel receiver head coil before and after the 10 iTBS sessions. Compared with task-based fMRI (tb-fMRI), we opted for rs-fMRI for several compelling reasons: (1) Participant Accessibility: tb-fMRI necessitates participants to be actively engaged, cooperative, and capable of executing specific tasks. However, these demands could pose challenges for individuals with CRCI, potentially leading to frustration or data collection failure. As a more accommodating alternative, rs-fMRI allows us to gather data without placing such cognitive demands on the participant [For resting-state functional connectivity (RSFC) analysis, we conducted a seed-based region of interest (ROI) to ROI approach, which allowed us to delve into the connectivity between the stimulation site and various other regions within the brain. The preprocessed low-frequency fMRI data were parceled into a set of 166 brain regions using Automated Anatomical Labeling (AAL) atlas 3 [To assess subjective symptomology, the patient was given a brief questionnaire on quality of life based on relevant items from the National Cancer Institute Patient-Reported Outcomes version Of The Common Terminology Criteria For Adverse Events (PRO-CTCAE™) (version 1.0) at 30, 90, and 120 days post treatment. PRO-CTCAE is a tool designed to capture patient-reported side effects and adverse events during cancer clinical trials. While PRO-CTCAE primarily focuses on the assessment of physical symptoms, it can be adapted to evaluate various aspects, such as sleep quality, mood states, and cognitive functions, including memory and attention. Previous oncology studies have employed PRO-CTCAE to specifically address ‘chemobrain’ [