Department of Radiation Oncology, Medical School Hannover, Hannover, Germany.
Int J Radiat Oncol Biol Phys. 2013 Nov 15;87(4):705-12. doi: 10.1016/j.ijrobp.2013.07.037. Epub 2013 Sep 21.
Patients with brain metastases may experience treatment-related cognitive deficits. In this study, we prospectively assessed the self-reported cognitive abilities of patients with brain metastases from any solid primary cancer before and after irradiation of the brain.
The treatment group (TG) consisted of adult patients (n=50) with brain metastases who received whole or partial irradiation of the brain without having received prior radiation therapy (RT). The control group (CG) consisted of breast cancer patients (n=27) without cranial involvement who were treated with adjuvant RT. Patients were recruited between May 2008 and December 2010. Self-reported cognitive abilities were acquired before RT and 6 weeks, 3 months, and 6 months after irradiation. The information regarding the neurocognitive status was collected by use of the German questionnaires for self-perceived deficits in attention (FEDA) and subjectively experienced everyday memory performance (FEAG).
The baseline data showed a high proportion of self-perceived neurocognitive deficits in both groups. A comparison between the TG and the CG regarding the course of self-reported outcomes after RT showed significant between-group differences for the FEDA scales 2 and 3: fatigue and retardation of daily living activities (P=.002) and decrease in motivation (P=.032) with an increase of attention deficits in the TG, but not in the CG. There was a trend towards significance in FEDA scale 1: distractibility and retardation of mental processes (P=.059) between the TG and the CG. The FEAG assessment presented no significant differences. An additional subgroup analysis within the TG was carried out. FEDA scale 3 showed significant differences in the time-related progress between patients with whole-brain RT and those receiving hypofractionated stereotactic RT (P=.025), with less decrease in motivation in the latter group.
Self-reported attention declined in patients with brain metastases after RT to the brain, whereas it remained relatively stable in breast cancer patients.
脑转移患者可能会经历与治疗相关的认知缺陷。在这项研究中，我们前瞻性地评估了来自任何实体原发癌的脑转移患者在脑照射前后的自我报告认知能力。
治疗组（TG）由 50 名接受全脑或部分脑照射而未接受过放疗（RT）的脑转移成年患者组成。对照组（CG）由 27 名无颅部受累的乳腺癌患者组成，他们接受辅助 RT 治疗。患者于 2008 年 5 月至 2010 年 12 月期间入组。在 RT 前和照射后 6 周、3 个月和 6 个月采集自我报告的认知能力信息。使用德国注意力自我感知缺陷问卷（FEDA）和主观体验日常记忆表现问卷（FEAG）收集有关神经认知状态的信息。
两组的基线数据均显示出较高比例的自我感知神经认知缺陷。RT 后自我报告结果的 TG 和 CG 之间的比较显示，在 FEDA 量表 2 和 3 方面存在显著的组间差异：疲劳和日常生活活动的延迟（P=.002）以及动机下降（P=.032），在 TG 中注意力缺陷增加，但在 CG 中则没有。FEDA 量表 1 方面存在显著差异：分心和心理过程延迟（P=.059），在 TG 和 CG 之间存在趋势。FEAG 评估未显示出显著差异。对 TG 内的一个亚组进行了额外的分析。FEDA 量表 3 显示，全脑 RT 与接受立体定向低分割 RT 的患者之间的时间相关性进展存在显著差异（P=.025），后者组的动机下降幅度较小。
脑转移患者在脑照射后自我报告的注意力下降，而乳腺癌患者则相对稳定。
