Department of Radiation Oncology, Rush University Medical Center, Chicago, IL.
Department of Radiation Oncology, Loyola University Medical Center, Maywood, IL.
Semin Oncol. 2014 Aug;41(4):532-540. doi: 10.1053/j.seminoncol.2014.06.001. Epub 2014 Jun 11.
This article gives a brief historical overview of the development of standard management for high-grade gliomas (HGGs). The current standard of care, trimodality therapy with maximal safe resection followed by involved-field radiotherapy (RT) with concomitant/adjuvant temozolomide, confers median survival of 14.6 months, and a modest but measurable proportion (9.8%) of patients survives 5 or more years. We review the toxicities associated with irradiation of the central nervous system for patients with HGG, with focus on the pathophysiology, clinical manifestations, and potential preventative strategies for long-term neurocognitive dysfunction, which remains a pervasive, progressive, and clinically devastating sequela of trimodality therapy. Treatment of cognitive decline after RT is limited, and strategies for preventing this complication are being investigated.
本文简要回顾了高级别胶质瘤（HGG）标准治疗的发展历程。目前的标准治疗方法是最大限度安全切除肿瘤后，采用适形或调强放疗联合替莫唑胺辅助治疗，中位生存期为 14.6 个月，仅有少数患者（9.8%）能够存活 5 年以上。我们回顾了与 HGG 患者中枢神经系统放疗相关的毒性，重点介绍了长期神经认知功能障碍的病理生理学、临床表现和潜在的预防策略，这仍然是适形或调强放疗联合替莫唑胺辅助治疗的普遍、进行性和临床破坏性后遗症。针对放疗后认知功能下降的治疗方法有限，目前正在研究预防这种并发症的策略。
