Radiation Oncology Unit, Azienda Ospedaliera, Universitaria Careggi, Viale Morgagni 85, 50134 Florence, Italy.
J Neurooncol. 2012 Jun;108(2):291-308. doi: 10.1007/s11060-012-0821-8. Epub 2012 Feb 18.
This review aims to summarize what is currently known about neurocognitive outcome and quality of life in patients with brain tumors treated with radiotherapy. Whether potential tumor-controlling benefits of radiotherapy outweigh its potential toxicity in the natural history of brain tumors is a matter of debate. This review focuses on some of the adult main brain tumors, for which the issue of neurocognitive decline has been thoroughly studied: low-grade gliomas, brain metastases, and primary central nervous system lymphomas. The aims of this review are: (1) the analysis of existing data regarding the relationship between radiotherapy and neurocognitive outcome; (2) the identification of strategies to minimize radiotherapy-related neurotoxicity by reducing the dose or the volume; (3) the evidence-based data concerning radiotherapy withdrawal; and (4) the definition of patients subgroups that could benefit from immediate radiotherapy. For high grade gliomas, the main findings from literature are summarized and some strategies to reduce the neurotoxicity of the treatment are presented. Although further prospective studies with adequate neuropsychological follow-up are needed, this article suggests that cognitive deficits in patients with brain tumor have a multifactorial genesis: radiotherapy may contribute to the neurocognitive deterioration, but the causes of this decline include the tumor itself, disease progression, other treatment modalities and comorbidities. Treatment variables, such as total and fractional dose, target volume, and irradiation technique can dramatically affect the safety of radiotherapy: optimizing radiation parameters could be an excellent approach to improve outcome and to reduce neurotoxicity. At the same time, delayed radiotherapy could be a valid option for highly selected patients.
这篇综述旨在总结目前关于接受放疗的脑肿瘤患者的神经认知结果和生活质量的相关知识。放疗在脑肿瘤的自然病程中是否具有潜在的肿瘤控制益处，超过其潜在的毒性，这是一个有争议的问题。本综述重点关注一些成人主要脑肿瘤，这些肿瘤的神经认知下降问题已经得到了深入研究：低级别胶质瘤、脑转移瘤和原发性中枢神经系统淋巴瘤。本综述的目的是：（1）分析关于放疗与神经认知结果之间关系的现有数据；（2）通过降低剂量或体积来确定最小化放疗相关神经毒性的策略；（3）基于循证数据来探讨放疗撤疗的问题；（4）定义可以从立即放疗中受益的患者亚组。对于高级别胶质瘤，本文总结了文献中的主要发现，并提出了一些降低治疗神经毒性的策略。尽管需要进一步进行前瞻性研究，并进行适当的神经心理学随访，但本文表明，脑肿瘤患者的认知缺陷具有多因素的成因：放疗可能导致神经认知恶化，但这种下降的原因包括肿瘤本身、疾病进展、其他治疗方式和合并症。治疗变量，如总剂量和分次剂量、靶区体积和照射技术，可显著影响放疗的安全性：优化放射参数可能是改善结果和降低神经毒性的一个极好方法。同时，延迟放疗可能是对高度选择的患者的有效选择。
