Riva Daria, Massimino Maura, Giorgi Cesare, Nichelli Francesca, Erbetta Alessandra, Usilla Arianna, Vago Chiara, Bulgheroni Sara
Developmental Neurology Division, Fondazione IRCCS Istituto Nazionale Neurologico C.Besta, Via Celoria, 1120133, Milan, Italy.
J Neurooncol. 2009 Mar;92(1):49-56. doi: 10.1007/s11060-008-9730-2. Epub 2008 Nov 14.
Studies on adults with cancer, with or without CNS involvement, have shown that chemotherapy (CT) can affect cognitive functions. Two studies on children with optic pathway gliomas, involving the hypothalamus in some cases, and treated with CT according to various protocols reported the children maintaining a good IQ (no other cognitive abilities were tested). Among 18 children with chiasmatic-hypothalamic tumors (CHT) given front-line CT treatment at our institute using the same protocol (cisplatin and etoposide), we screened eight children for cognitive sequelae, correlating their test performance with several clinical variables (age at diagnosis and at time of treatment, time elapsing since treatment, and tumor volume reduction). The neuropsychological evaluation involved measuring IQ in all eight children and cognitive flexibility in three before CT (T1), then testing IQ, attention, memory and executive functions after CT (T2). The group as a whole showed no signs of any decline in IQ from T1 to T2, except for some WISC items, but IQ deteriorated severely in three patients with NF1 (only suspected in one case). At T2, the whole sample performed within normal range, except for two children showing a significantly worse result in two specific tests. The parents of the other 10 children, reported no substantial changes in their children's behavior and intellectual vivacity in a semistructured telephone interview conducted in cooperation with the children's teachers. CT alone as front-line treatment for CHT does not appear to have a negative effect on IQ and numerous neuropsychological tests. Some skills were more affected than others in our sample (albeit with a very low statistical significance of the impairment), and some patients seemed to be more vulnerable than others after CT. The multifactorial origin of such cognitive impairments is discussed. This type of study needs to be repeated in larger, but nonetheless carefully selected groups of patients.
对患有癌症的成年人（无论是否有中枢神经系统受累）的研究表明，化疗（CT）会影响认知功能。两项针对患有视路胶质瘤儿童的研究（部分病例累及下丘脑），根据不同方案进行CT治疗，结果显示这些儿童的智商保持良好（未测试其他认知能力）。在我院按照相同方案（顺铂和依托泊苷）接受一线CT治疗的18例患有视交叉 - 下丘脑肿瘤（CHT）的儿童中，我们筛选了8名儿童以评估认知后遗症，将他们的测试表现与几个临床变量（诊断时和治疗时的年龄、治疗后经过的时间以及肿瘤体积缩小情况）相关联。神经心理学评估包括在CT治疗前（T1）测量所有8名儿童的智商以及其中3名儿童的认知灵活性，然后在CT治疗后（T2）测试智商、注意力、记忆力和执行功能。总体而言，除了一些韦氏智力量表项目外，从T1到T2整个组没有智商下降的迹象，但3例患有神经纤维瘤病1型（NF1）的患者智商严重恶化（仅1例为疑似病例）。在T2时，除了两名儿童在两项特定测试中结果明显较差外，整个样本的表现均在正常范围内。在与儿童教师合作进行的半结构化电话访谈中，其他10名儿童的家长报告称他们孩子的行为和智力活力没有实质性变化。单独使用CT作为CHT的一线治疗似乎对智商和众多神经心理学测试没有负面影响。在我们的样本中，某些技能比其他技能受影响更大（尽管损伤的统计学意义非常低），并且一些患者在CT治疗后似乎比其他患者更易受影响。本文讨论了此类认知障碍的多因素成因。这种类型的研究需要在更大但经过精心挑选的患者群体中重复进行。
