Edelstein Kim, Richard Nadine M, Bernstein Lori J
Department of Supportive Care, Princess Margaret Cancer Centre; Department of Psychiatry, University of Toronto, Toronto, Canada.
Curr Opin Support Palliat Care. 2017 Mar;11(1):32-37. doi: 10.1097/SPC.0000000000000255.
Radiation to the brain is associated with adverse effects on cognition in cancer patients. Advances in technology have improved treatment efficacy, while new or adjuvant approaches continue to be developed. The long-term impact of both established and newer treatments on cognition is an active area of research.
The article reviews the 15 studies published between January 2015 and October 2016 that include data on neurocognitive functions following radiation to the brain in adults with brain metastases, primary brain tumors, or other cancers. These studies examine neurocognitive outcomes in relation to radiation treatment delivery, pharmacological interventions, and biomarkers of brain injury.
Advances in radiotherapy protocols have reduced neurotoxic side-effects. Implementation of standardized, validated neurocognitive measures and biomarkers of brain injury provide new insights into the impact of cranial radiation on cognitive functions. Several promising new lines of research will benefit from further study to address common challenges in the field, including high rates of attrition in longitudinal trials, absence of control groups, small sample sizes, and heterogeneous patient groups.
脑部放疗会给癌症患者的认知功能带来不良影响。技术进步提高了治疗效果,同时新的或辅助治疗方法也在不断研发。已确立的治疗方法和新治疗方法对认知的长期影响是一个活跃的研究领域。
本文回顾了2015年1月至2016年10月期间发表的15项研究,这些研究包含了脑转移瘤、原发性脑肿瘤或其他癌症的成年患者脑部放疗后神经认知功能的数据。这些研究考察了与放射治疗实施、药物干预和脑损伤生物标志物相关的神经认知结果。
放疗方案的进步减少了神经毒性副作用。标准化、经过验证的神经认知测量方法和脑损伤生物标志物的应用为颅骨放疗对认知功能的影响提供了新的见解。若干有前景的新研究方向将受益于进一步的研究,以应对该领域的常见挑战,包括纵向试验中的高损耗率、缺乏对照组、样本量小以及患者群体异质性等问题。