Radiology Unit, Department of Experimental, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
Department of Experimental, Radiation Oncology Center, Diagnostic and Specialty Medicine - DIMES, University of Bologna, Bologna, Italy.
J Cancer Res Ther. 2020 Oct-Dec;16(6):1215-1222. doi: 10.4103/jcrt.JCRT_573_17.
Whole-brain radiation therapy (WBRT) is an effective therapeutic modality in patients with brain metastases. However, nearly 90% of patients undergoing WBRT suffer from a neurocognitive function (NCF) impairment at diagnosis, and up to two-thirds will experience a further decline within 2-6 months after WBRT. Focal-dose reduction on bilateral hippocampus is thought to improve NCF preservation. The aim was to present a systematic review of clinical results on NCF after hippocampal-sparing (HS) WBRT.
A systematic review of published literature was performed on PubMed and the Cochrane Library. Only prospective clinical trials reporting NCF outcome in patients treated with HS-WBRT have been analyzed.
A total of 165 patients from three studies were included. These studies are characterized by small sample size and different methods in terms of WBRT technique but with similar planning analysis and NCF assessment tests. No significant changes in NCF (i.e., verbal and nonverbal learning memory, executive functions, and psychomotor speed) between baseline and 4-month follow-up after RT and only a mean relative decline in delayed recall at 4 months (7% compared to 30% of historical control) were observed.
Considering preliminary results on NCF preservation, further studies seem justified in patients undergoing brain irradiation for brain metastases or referred for prophylactic cranial irradiation to evaluate long-term effects on NCF and quality of life.
全脑放射治疗（WBRT）是治疗脑转移瘤患者的有效治疗方法。然而，近 90%接受 WBRT 的患者在诊断时存在神经认知功能（NCF）损伤，多达三分之二的患者在 WBRT 后 2-6 个月内会进一步下降。双侧海马体的局部剂量减少被认为可以改善 NCF 的保存。本研究旨在对海马体保护（HS）WBRT 后 NCF 的临床结果进行系统评价。
在 PubMed 和 Cochrane 图书馆上对已发表的文献进行了系统评价。仅分析了报告接受 HS-WBRT 治疗的患者 NCF 结果的前瞻性临床试验。
共有来自三项研究的 165 名患者被纳入。这些研究的特点是样本量小，WBRT 技术方面的方法不同，但计划分析和 NCF 评估测试相似。在 RT 后 4 个月的随访中，NCF（即言语和非言语学习记忆、执行功能和精神运动速度）没有明显变化，只有在 4 个月时延迟回忆的平均相对下降（与历史对照组的 30%相比，下降了 7%）。
考虑到 NCF 保存的初步结果，对于接受脑转移放疗或预防性颅照射的患者，进一步的研究似乎是合理的，以评估对 NCF 和生活质量的长期影响。
