立体定向放射治疗脑转移瘤患者的神经认知功能与健康相关生活质量：一项前瞻性研究。
Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study.
作者信息
Habets Esther J J, Dirven Linda, Wiggenraad Ruud G, Verbeek-de Kanter Antoinette, Lycklama À Nijeholt Geert J, Zwinkels Hanneke, Klein Martin, Taphoorn Martin J B
机构信息
Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
出版信息
Neuro Oncol. 2016 Mar;18(3):435-44. doi: 10.1093/neuonc/nov186. Epub 2015 Sep 18.
BACKGROUND
Stereotactic radiotherapy (SRT) is expected to have a less detrimental effect on neurocognitive functioning and health-related quality of life (HRQoL) than whole-brain radiotherapy. To evaluate the impact of brain metastases and SRT on neurocognitive functioning and HRQoL, we performed a prospective study.
METHODS
Neurocognitive functioning and HRQoL of 97 patients with brain metastases were measured before SRT and 1, 3, and 6 months after SRT. Seven cognitive domains were assessed. HRQoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BN20 questionnaires. Neurocognitive functioning and HRQoL over time were analyzed with linear mixed models and stratified for baseline Karnofsky performance status (KPS), total metastatic volume, and systemic disease.
RESULTS
Median overall survival of patients was 7.7 months. Before SRT, neurocognitive domain and HRQoL scores were lower in patients than in healthy controls. At group level, patients worsened in physical functioning and fatigue at 6 months, while other outcome parameters of HRQoL and cognition remained stable. KPS < 90 and tumor volume >12.6 cm(3) were both associated with worse information processing speed and lower HRQoL scores over 6 months time. Intracranial tumor progression was associated with worsening of executive functioning and motor function.
CONCLUSIONS
Prior to SRT, neurocognitive functioning and HRQoL are moderately impaired in patients with brain metastases. Lower baseline KPS and larger tumor volume are associated with worse functioning. Over time, SRT does not have an additional detrimental effect on neurocognitive functioning and HRQoL, suggesting that SRT may be preferred over whole-brain radiotherapy.
背景
立体定向放射治疗（SRT）对神经认知功能和健康相关生活质量（HRQoL）的不良影响预计比全脑放射治疗要小。为了评估脑转移瘤和SRT对神经认知功能及HRQoL的影响，我们进行了一项前瞻性研究。
方法
对97例脑转移瘤患者在SRT前以及SRT后1个月、3个月和6个月时的神经认知功能和HRQoL进行测量。评估了七个认知领域。使用欧洲癌症研究与治疗组织（EORTC）的QLQ-C30和BN20问卷评估HRQoL。采用线性混合模型分析神经认知功能和HRQoL随时间的变化情况，并根据基线卡诺夫斯基表现状态（KPS）、总转移瘤体积和全身疾病进行分层。
结果
患者的中位总生存期为7.7个月。在SRT前，患者的神经认知领域和HRQoL评分低于健康对照组。在组水平上，患者在6个月时身体功能和疲劳状况恶化，而HRQoL和认知的其他结局参数保持稳定。KPS<90以及肿瘤体积>12.6 cm³均与6个月内较差的信息处理速度和较低的HRQoL评分相关。颅内肿瘤进展与执行功能和运动功能恶化有关。
结论
在SRT之前，脑转移瘤患者的神经认知功能和HRQoL受到中度损害。较低的基线KPS和较大的肿瘤体积与较差的功能相关。随着时间的推移，SRT对神经认知功能和HRQoL没有额外的不良影响，这表明SRT可能比全脑放射治疗更可取。
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