Schagen S B, Muller M J, Boogerd W, Rosenbrand R M, van Rhijn D, Rodenhuis S, van Dam F S A M
Department of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Ann Oncol. 2002 Sep;13(9):1387-97. doi: 10.1093/annonc/mdf241.
Neuropsychological examinations have shown an elevated risk for cognitive impairment 2 years after therapy in breast cancer patients randomized to receive adjuvant high-dose cyclophosphamide, thiotepa, carboplatin (CTC) chemotherapy compared with a non-treated control group of stage I breast cancer patients. Patients randomized to receive standard-dose fluorouracil, epirubicin, cyclophosphamide (FEC) chemotherapy showed no elevated risk compared with controls. However, breast cancer patients treated with conventional cyclophosphamide, methotrexate, 5-fluorouracil (CMF) chemotherapy showed a higher risk of cognitive impairment. The present study was designed to obtain a greater insight into these long-term neuropsychological sequelae following chemotherapy and their course in time.
At 4 years post-therapy, 22 of the original 34 CTC patients, 23 of 36 FEC patients, 31 of 39 CMF patients and 27 of 34 control patients were re-examined with neuropsychological tests.
Improvement in performance was observed in all chemotherapy groups, whereas in the control group there was a slight deterioration in test results. A differential attrition was observed among the groups, with a relatively high percentage of initially cognitively impaired patients from the CTC group dropping out due to factors related to disease progression.
The results suggest that cognitive dysfunction following adjuvant chemotherapy in breast cancer patients may be transient. Additional studies are needed to investigate the differential attrition of patients with cognitive impairment.
神经心理学检查显示，与未接受治疗的I期乳腺癌患者对照组相比，随机接受辅助高剂量环磷酰胺、噻替派、卡铂（CTC）化疗的乳腺癌患者在治疗后2年出现认知障碍的风险升高。随机接受标准剂量氟尿嘧啶、表柔比星、环磷酰胺（FEC）化疗的患者与对照组相比，未显示出风险升高。然而，接受传统环磷酰胺、甲氨蝶呤、5-氟尿嘧啶（CMF）化疗的乳腺癌患者出现认知障碍的风险更高。本研究旨在更深入地了解化疗后的这些长期神经心理学后遗症及其随时间的发展过程。
治疗后4年，对最初34例CTC患者中的22例、36例FEC患者中的23例、39例CMF患者中的31例以及34例对照患者中的27例进行了神经心理学测试复查。
所有化疗组的测试表现均有改善，而对照组的测试结果略有恶化。各治疗组间存在差异失访情况，CTC组中最初认知受损的患者因疾病进展相关因素退出研究的比例相对较高。
结果表明，乳腺癌患者辅助化疗后的认知功能障碍可能是短暂的。需要进一步研究来调查认知受损患者的差异失访情况。
