Duffner Patricia K
Department of Neurology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 219 Bryant Street, Buffalo, NY 14222, USA.
Neurologist. 2004 Nov;10(6):293-310. doi: 10.1097/01.nrl.0000144287.35993.96.
As the number of long-term survivors of childhood cancer has grown, it has become increasingly clear that central nervous system therapy may have serious long-term effects on cognition and endocrine function. These complications have been studied most extensively in children with brain tumors and leukemia.
Children with acute lymphoblastic leukemia previously treated with cranial irradiation are at risk for cognitive decline. Chemotherapy-only regimens, which rely on high-dose frequently administered methotrexate, are also associated with producing cognitive dysfunction. Children irradiated for brain tumors are even more vulnerable. Risk factors include perioperative morbidity, young age, large-volume high-dose cranial irradiation, supra-tentorial location of tumor, moyamoya syndrome, and leukoencephalopathy. Cognitive decline is progressive over at least a decade. The most common radiation-induced endocrinopathies are hypothyroidism and growth hormone deficiency. Treatment effects on growth are multifactorial and include growth hormone deficiency,spinal shortening, precocious puberty, undetected hypothyroidism,and poor nutrition. Fifty percent to 80% of children treated with craniospinal radiation for brain tumors will experience growth failure. In hopes of reducing neurotoxicity, current treatments limit the dose and volume of radiation while adding chemotherapy. Results have not been uniformly positive, however, and may increase toxicity in some cases.
The standard of care in 2004 is that children who have been treated for brain tumors and leukemia should be monitored for cognitive and endocrine dysfunction. Until effective non-neurotoxic treatment is identified, long-term effects assessments are essential to maximize the quality of life of survivors of childhood cancer.
随着儿童癌症长期存活者数量的增加，越来越明显的是中枢神经系统治疗可能对认知和内分泌功能产生严重的长期影响。这些并发症在患有脑肿瘤和白血病的儿童中得到了最广泛的研究。
先前接受过颅脑照射治疗的急性淋巴细胞白血病患儿有认知功能下降的风险。仅采用化疗的方案，即依赖高剂量频繁给药的甲氨蝶呤，也与产生认知功能障碍有关。接受脑肿瘤照射的儿童甚至更易出现问题。危险因素包括围手术期发病率、年龄小、大剂量大容量颅脑照射、肿瘤位于幕上、烟雾病综合征和白质脑病。认知功能下降至少在十年内呈进行性发展。最常见的辐射诱导内分泌病是甲状腺功能减退和生长激素缺乏。治疗对生长的影响是多因素的，包括生长激素缺乏、脊柱缩短、性早熟、未被发现的甲状腺功能减退和营养不良。50%至80%接受脑肿瘤颅脊髓照射治疗的儿童会出现生长发育迟缓。为了减少神经毒性，目前的治疗方法在增加化疗的同时限制了辐射剂量和范围。然而，结果并不一致积极，在某些情况下可能会增加毒性。
2004年的护理标准是，应对接受过脑肿瘤和白血病治疗儿童的认知和内分泌功能障碍进行监测。在确定有效的非神经毒性治疗方法之前，长期影响评估对于最大限度提高儿童癌症幸存者的生活质量至关重要。
