Wefel Jeffrey S, Parsons Michael W, Gondi Vinai, Brown Paul D
Section of Neuropsychology, Department of Neuro-Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States.
Section of Neuropsychology, Burkhardt Brain Tumor Center, Cleveland Clinic, Cleveland, OH, United States.
Handb Clin Neurol. 2018;149:155-165. doi: 10.1016/B978-0-12-811161-1.00012-8.
Brain metastases are common, occurring in approximately 20% of cancer patients. One of the biggest concerns for these patients and their families is neurocognitive decline. Neurocognitive issues in this patient population are complex and many patients have neurocognitive impairment due to systemic therapies even before they develop brain metastases. The development of brain metastases as well as the treatment of these tumors can cause decline in neurocognitive function. Diffuse treatments such as whole-brain radiotherapy are more frequently associated with neurocognitive decline than focal interventions such as radiosurgery, surgical resection, and implantable chemotherapy wafers. For patients with brain metastases treatment decisions require a multidisciplinary approach, balancing many factors including the neurocognitive impact of treatment and the disease process itself. Finally, to continue to advance the field there needs to be continued utilization, both off and on clinical trial, of performance-based clinical outcome assessments (i.e., neurocognitive tests) to objectively assess and measure the neurocognitive outcomes of these patients.
脑转移瘤很常见，约20%的癌症患者会出现。这些患者及其家属最担心的问题之一是神经认知功能衰退。该患者群体的神经认知问题很复杂，许多患者甚至在发生脑转移之前就因全身治疗而出现神经认知障碍。脑转移瘤的发生以及这些肿瘤的治疗都会导致神经认知功能下降。与立体定向放射治疗、手术切除和可植入化疗晶片等局部干预措施相比，全脑放疗等广泛性治疗更常与神经认知功能下降相关。对于脑转移瘤患者，治疗决策需要多学科方法，平衡许多因素，包括治疗对神经认知的影响以及疾病进程本身。最后，为了继续推动该领域的发展，需要在临床试验内外持续使用基于表现的临床结局评估（即神经认知测试），以客观评估和测量这些患者的神经认知结局。
