Packer R J, Sutton L N, Atkins T E, Radcliffe J, Bunin G R, D'Angio G, Siegel K R, Schut L
Neuro-Oncology Program, Children's Hospital of Philadelphia, Pennsylvania.
J Neurosurg. 1989 May;70(5):707-13. doi: 10.3171/jns.1989.70.5.0707.
As survival rates have risen for children with malignant primary brain tumors, so has the concern that many survivors have significant permanent cognitive deficits. Cranial irradiation (CRT) has been implicated as the major cause for cognitive dysfunction. To clarify the etiology, incidence, and severity of intellectual compromise in children with brain tumors after CRT, a prospective study was undertaken comparing the neuropsychological outcome in 18 consecutive children with malignant brain tumors treated with CRT to outcome in 14 children harboring brain tumors in similar sites in the nervous system who had not received CRT. Children with cortical or subcortical brain tumors were not eligible for study. Neuropsychological testing was performed after surgery prior to radiotherapy, after radiotherapy, and at 1- and 2-year intervals thereafter. Children who had received CRT had a mean full-scale intelligence quotient (FSIQ) of 105 at diagnosis which fell to 91 by Year 2. Similar declines were noted in their performance intelligence quotient (IQ) and verbal IQ. After CRT, patients demonstrated a statistically significant decline from baseline in FSIQ (p less than 0.02) and verbal IQ (p less than 0.04). Children who had not received CRT did not demonstrate a fall in any cognitive parameter over time. The decline between baseline testing and testing performed at Year 2 in patients who had CRT was inversely correlated with age (p less than 0.02), as younger children demonstrated the greatest loss of intelligence. Children less than 7 years of age at diagnosis had a mean decline in FSIQ of 25 points 2 years posttreatment. No other clinical parameter correlated with the overall IQ or decline in IQ. After CRT, children demonstrated a wide range of dysfunction including deficits in fine motor, visual-motor, and visual-spatial skills and memory difficulties. After CRT, children with brain tumors also demonstrated a fall in a wide range of achievement scores and an increased need, over time, for special help in school. The 2-year results of this study suggest that children with brain tumors treated with CRT are cognitively impaired and that these deficits worsen over time. The younger the child is at the time of treatment, the greater is the likelihood and severity of damage. These children, although not retarded, have a multitude of neurocognitive deficits which detrimentally affects school performance. New treatment strategies are needed for children with malignant brain tumors.
随着原发性恶性脑肿瘤患儿生存率的提高，人们越来越担心许多幸存者存在明显的永久性认知缺陷。头颅放疗（CRT）被认为是认知功能障碍的主要原因。为了阐明接受CRT治疗的脑肿瘤患儿智力损害的病因、发生率和严重程度，进行了一项前瞻性研究，比较了18例连续接受CRT治疗的恶性脑肿瘤患儿与14例未接受CRT治疗但神经系统肿瘤部位相似的患儿的神经心理学结果。患有皮质或皮质下脑肿瘤的儿童不符合研究条件。在放疗前手术后、放疗后以及此后1年和2年的间隔时间进行神经心理学测试。接受CRT治疗的儿童在诊断时的平均全量表智商（FSIQ）为105，到第2年降至91。其操作智商（IQ）和言语智商也有类似下降。CRT治疗后，患者的FSIQ（p<0.02）和言语智商（p<0.04）较基线有统计学意义的下降。未接受CRT治疗的儿童在任何认知参数上均未随时间下降。接受CRT治疗的患者在基线测试和第2年测试之间的下降与年龄呈负相关（p<0.02），因为年龄较小的儿童智力损失最大。诊断时年龄小于7岁的儿童在治疗后2年FSIQ平均下降25分。没有其他临床参数与总体智商或智商下降相关。CRT治疗后，儿童表现出广泛的功能障碍，包括精细运动、视觉运动和视觉空间技能缺陷以及记忆困难。CRT治疗后，脑肿瘤患儿的各种学业成绩分数也有所下降，并且随着时间的推移，在学校获得特殊帮助的需求增加。这项研究的2年结果表明，接受CRT治疗的脑肿瘤患儿存在认知障碍，并且这些缺陷会随着时间的推移而恶化。治疗时年龄越小，受损的可能性和严重程度就越大。这些儿童虽然不迟钝，但有多种神经认知缺陷，对学业成绩有不利影响。恶性脑肿瘤患儿需要新的治疗策略。
