Dhermain Frédéric, Barani Igor J
Radiation Oncology Department, Gustave Roussy University Hospital, Villejuif, France.
Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA.
Handb Clin Neurol. 2016;134:219-34. doi: 10.1016/B978-0-12-802997-8.00013-X.
Radiotherapy (RT) of the brain is associated with significant stigma in the neuro-oncology community. This is primarily because of the potentially severe complications with which it may be associated. These complications, especially in subacute and latent settings, are often unpredictable, potentially progressive, and irreversible. The onset of complications may start from the first fraction of 2 Gy, continuing over several months after end of RT with persistent drowsiness and apathy. It may also extend over many years with progressive onset of neurocognitive impairments such as memory decline, and diminished focus/attention. For long-term survivors, such as young patients irradiated for a favorable low-grade glioma, quality of life can be seriously impacted by RT. It is essential, as in the pediatric field, to propose patient-specific regimens from the very outset of therapy. The use of molecular biomarkers to better predict survival, control of comorbidities along with judicious use of medications such as steroids and antiepileptics, improved targeting with the help of modern imaging and RT techniques, modulation of the dose, and fractionation aimed at limiting integral dose to the healthy brain all have the potential to minimize treatment-related complications while maintaining the therapeutic efficacy for which RT is known. Sparing "radiosensitive" areas such as hippocampi could have a modest but measurable impact with regard to cognitive preservation, an effect that can possibly be enhanced when used in conjunction with memantine and/or donepezil.
脑部放射治疗（RT）在神经肿瘤学界存在显著的污名化现象。这主要是因为它可能会引发潜在的严重并发症。这些并发症，尤其是在亚急性和潜伏阶段，往往不可预测，可能会进展，且不可逆转。并发症可能从首次2 Gy剂量照射时就开始出现，在放疗结束后的几个月里持续存在嗜睡和冷漠症状。它也可能会在多年间逐渐出现神经认知障碍，如记忆力下降、注意力不集中等。对于长期存活者，如因低级别胶质瘤接受放疗的年轻患者，放疗会严重影响其生活质量。与儿科领域一样，从治疗一开始就提出针对患者的治疗方案至关重要。使用分子生物标志物来更好地预测生存情况、控制合并症，同时合理使用类固醇和抗癫痫药物等药物，借助现代成像和放疗技术改进靶向治疗，调整剂量以及进行分割放疗以限制对健康脑组织的总剂量，所有这些都有可能在维持放疗已知疗效的同时，将治疗相关并发症降至最低。保护海马体等“放射敏感”区域对认知功能的保留可能会产生适度但可测量的影响，当与美金刚和/或多奈哌齐联合使用时，这种效果可能会增强。
