Burger Hester, Vernimmen Frederik J A I, Dugmore Diane, Parkes Jeannette D, Balchin Ross M
Department of Radiation Oncology, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa.
Previously from Department of Radiation Oncology, Netcare N1 City Hospital, Cape Town South Africa.
J Radiosurg SBRT. 2014;3(1):1-11.
To fully evaluate the efficacy of intracranial stereotactic irradiation, tumour control needs to be assessed in conjunction with the effects of radiation on normal tissue and the potential for changes in physiology, cognition and quality of life. This prospective pilot study investigated whether intracranial stereotactic irradiation induces cognitive changes in patients with cranial and base of skull lesions that did not directly involve the brain parenchyma. The value of a software-based psychometric approach to neurocognitive testing was also examined.
Thirty-four patients were enrolled, with 23 having sufficient data for statistical analyses. Pre-treatment baseline composite test score results for memory, attention, motor, language, executive function, and social function were compared to post-radiotherapy scores at final evaluation (median follow-up 24 months, range 12-59 months). Testing was done using the Brain Resource Company® (BRC) Internet accessed cognitive function test batteries, namely the WebNeuro® and IntegNeuro®, and the BRISC® (Brain Resource Inventory for Social Cognition).
Quantitative results revealed no overall decline in cognitive function, and improvement in both executive functioning (p = 0.0002) and social functioning (p = 0.0016). Qualitatively, 6 patients at the final endpoint, and 4 patients at 12 months, were found to have a decline in one or more domains of function; with some of the patients who declined also showing improvement in certain domains.
Overall, no statistically significant evidence of cognitive decline was observed following intracranial stereotactic irradiation, at either 12 months or beyond.
为全面评估颅内立体定向放射治疗的疗效，需要结合辐射对正常组织的影响以及生理、认知和生活质量变化的可能性来评估肿瘤控制情况。这项前瞻性试点研究调查了颅内立体定向放射治疗是否会在未直接累及脑实质的颅部和颅底病变患者中引起认知变化。还研究了基于软件的心理测量方法在神经认知测试中的价值。
招募了34名患者，其中23名有足够的数据进行统计分析。将治疗前记忆、注意力、运动、语言、执行功能和社会功能的综合测试基线评分结果与最终评估时（中位随访24个月，范围12 - 59个月）的放疗后评分进行比较。测试使用Brain Resource Company®（BRC）的互联网认知功能测试电池，即WebNeuro®和IntegNeuro®，以及BRISC®（社会认知脑资源量表）。
定量结果显示认知功能没有整体下降，执行功能（p = 0.0002）和社会功能（p = 0.0016）均有改善。定性分析发现，6名患者在最终终点时，4名患者在12个月时，有一个或多个功能领域出现下降；部分功能下降的患者在某些领域也有改善。
总体而言，在颅内立体定向放射治疗后12个月及以后，未观察到有统计学意义的认知功能下降证据。
