Brown Paul D, Buckner Jan C, O'Fallon Judith R, Iturria Nancy L, Brown Cerise A, O'Neill Brian P, Scheithauer Bernd W, Dinapoli Robert P, Arusell Robert M, Curran Walter J, Abrams Ross, Shaw Edward G
Mayo Clinic, Division of Radiation Oncology, Rochester, MN 55905, USA.
J Clin Oncol. 2003 Jul 1;21(13):2519-24. doi: 10.1200/JCO.2003.04.172.
To assess the neurocognitive effects of cranial radiotherapy on patients with low-grade gliomas, we analyzed cognitive performance data collected in a prospective, intergroup clinical trial.
Patients included 203 adults with supratentorial low-grade gliomas randomly assigned to a lower dose (50.4 Gy in 28 fractions) or a higher dose (64.8 Gy in 36 fractions) of localized radiotherapy. Folstein Mini-Mental State Examination (MMSE) scores and neurologic function scores (NFS) at baseline and key evaluations were analyzed. Median follow-up was 7.4 years in 101 patients still alive. A change of more than three MMSE points was considered clinically significant.
In patients without tumor progression, significant deterioration from baseline occurred at years 1, 2, and 5 in 8.2%, 4.6%, and 5.3% of patients, respectively. Most patients with an abnormal baseline MMSE score (< 27) experienced significant increases. Baseline variables such as radiation dose, conformal versus conventional radiotherapy, number of radiation fields, age, sex, tumor size, NFS, seizures, and seizure medications did not predict cognitive function changes.
In this population, most low-grade glioma patients maintained a stable neurocognitive status after focal radiotherapy as measured by the MMSE. Patients with an abnormal baseline MMSE were more likely to have an improvement in cognitive abilities than deterioration after receiving radiotherapy. Only a small percentage of patients had cognitive deterioration after radiotherapy. However, more discriminating neurocognitive assessment tools may identify cognitive decline not apparent with the use of the MMSE.
为评估头颅放疗对低级别胶质瘤患者的神经认知影响，我们分析了在前瞻性组间临床试验中收集的认知功能数据。
患者包括203例幕上低级别胶质瘤成人患者，他们被随机分配接受低剂量（28次分割，共50.4 Gy）或高剂量（36次分割，共64.8 Gy）的局部放疗。分析了基线及关键评估时的简易精神状态检查表（MMSE）评分和神经功能评分（NFS）。101例仍存活患者的中位随访时间为7.4年。MMSE评分变化超过3分被认为具有临床意义。
在无肿瘤进展的患者中，分别有8.2%、4.6%和5.3%的患者在第1年、第2年和第5年出现了相较于基线的显著恶化。大多数基线MMSE评分异常（<27分）的患者出现了显著升高。诸如放疗剂量、适形放疗与传统放疗、放疗野数量、年龄、性别、肿瘤大小、NFS、癫痫发作及抗癫痫药物等基线变量并不能预测认知功能变化。
在该人群中，通过MMSE评估，大多数低级别胶质瘤患者在局部放疗后保持了稳定的神经认知状态。基线MMSE评分异常的患者在接受放疗后认知能力改善的可能性大于恶化的可能性。放疗后仅有一小部分患者出现认知功能恶化。然而，更具鉴别力的神经认知评估工具可能会识别出使用MMSE时未显现的认知衰退。
