Ricard D, De Greslan T, Soussain C, Bounolleau P, Sallansonnet-Froment M, Delmas J-M, Taillia H, Martin-Duverneuil N, Renard J-L, Hoang-Xuan K
Service de neurologie, HIA du Val-de-grâce, 74, boulevard Port-Royal, 75005 Paris, France.
Rev Neurol (Paris). 2008 Jun-Jul;164(6-7):575-87. doi: 10.1016/j.neurol.2008.03.014. Epub 2008 Jun 9.
Damage to the central nervous system induced by treatment of brain tumors is common and impairs the patient quality-of-life. Neurotoxicity is induced by synergistic effects of different cytotoxic treatments such as radiotherapy and chemotherapies administered concurrently or sequentially. Recent progress in the management of brain tumors has led to new neurotoxicities. The growing concern about the neuropsychological performance of patients has disclosed another type of brain damage which has been largely neglected to date. Neurological toxicity can be acute, requiring dose adaptation or a change of drugs. But it also often occurs late and can be irreversible. To date, treatments have been ineffective. The early diagnosis of neurotoxicity is thus a major challenge. Numerous clinical studies suggest an individual sensitivity which is not only related to age or vascular status, but also to genetic predisposition that remains to be detailed. Understanding the mechanisms of personal susceptibilities would be helpful in designing more tailored treatments. In this review we address the question of adverse effects of brain radiation as well as those of chemotherapy protocols which are particularly toxic for the central nervous system that is, methotrexate, platin and aracytin.
脑肿瘤治疗引起的中枢神经系统损伤很常见，会损害患者的生活质量。神经毒性是由不同细胞毒性治疗（如同时或序贯给予的放疗和化疗）的协同作用引起的。脑肿瘤治疗管理方面的最新进展导致了新的神经毒性。对患者神经心理表现的日益关注揭示了另一种迄今为止在很大程度上被忽视的脑损伤类型。神经毒性可以是急性的，需要调整剂量或更换药物。但它也经常在后期出现，并且可能是不可逆的。迄今为止，治疗方法一直无效。因此，神经毒性的早期诊断是一项重大挑战。众多临床研究表明，个体敏感性不仅与年龄或血管状况有关，还与有待详细研究的遗传易感性有关。了解个体易感性的机制将有助于设计更具针对性的治疗方法。在这篇综述中，我们探讨了脑辐射的不良反应以及对中枢神经系统特别有毒性的化疗方案的不良反应，即甲氨蝶呤、铂类和阿糖胞苷。
