Durand Thomas, Bernier Marie-Odile, Léger Isabelle, Taillia Hervé, Noël Georges, Psimaras Dimitri, Ricard Damien
aUMR 8257 Cognition And Action Group, Université Paris Descartes, Centre National de la Recherche Scientifique, Service de Santé des Armée, Paris bInstitut de Radioprotection et de Sureté nucléaire, Fontenay-Aux-Roses cInstitut Gustave Roussy, Villejuif dHôpital d'instruction des armées du Val-De-Grâce, Service de Neurologie, Paris eCentre de Lutte contre le Cancer Paul-Strauss, Strasbourg fHôpital de la Pitié-Salpêtrière, Service de Neuro-Oncologie Mazarin, Paris, France.
Curr Opin Oncol. 2015 Nov;27(6):510-5. doi: 10.1097/CCO.0000000000000227.
Survival of brain tumor patients has increased with improvements in cancer treatments. However, treatments like radiotherapy can be neurotoxic and thus new end-points in clinical trials, as well as in individual management, have appeared. This article reviews the cognitive outcomes after radiotherapy in brain tumor patients, focusing on radiation-induced impairments, and then discusses actual cognitive assessment limitations.
Although physiopathology of radiation-induced cognitive impairments remains elusive, a general course can be described as acute, early-delayed, and late-delayed effects corresponding to different processes. The last is of high interest because the related impairments are irreversible. In this context, a cognitive assessment should be performed as often as possible, but actual tools are unfortunately not developed. Nevertheless, with respect to neuro-oncologic specificities, new cognitive tools could be developed to overcome these limitations.
Improvements in neuropsychologic assessment for brain tumor patients are urgently needed. A dynamic vision of radiation-induced cognitive impairments appears inevitable and should lead to a change in actual considerations about neurotoxicity follow-up.
随着癌症治疗水平的提高，脑肿瘤患者的生存率有所增加。然而，像放疗这样的治疗可能具有神经毒性，因此临床试验以及个体治疗中的新终点已经出现。本文回顾了脑肿瘤患者放疗后的认知结果，重点关注辐射诱发的损伤，然后讨论了实际认知评估的局限性。
尽管辐射诱发认知损伤的病理生理学仍不明确，但一般过程可描述为对应不同过程的急性、早期延迟和晚期延迟效应。最后一种效应备受关注，因为相关损伤是不可逆的。在这种情况下，应尽可能频繁地进行认知评估，但遗憾的是目前尚未开发出实际可用的工具。然而，考虑到神经肿瘤学的特殊性，可以开发新的认知工具来克服这些局限性。
迫切需要改进针对脑肿瘤患者的神经心理学评估。对辐射诱发认知损伤的动态认识似乎不可避免，这应该会导致对神经毒性随访的实际考虑发生变化。
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