Copeland D R, Dowell R E, Fletcher J M, Bordeaux J D, Sullivan M P, Jaffe N, Frankel L S, Ried H L, Cangir A
Department of Pediatrics, University of Texas M.D. Anderson Hospital and Tumor Institute, Houston 77030.
J Child Neurol. 1988 Jan;3(1):53-62. doi: 10.1177/088307388800300113.
The potential neuropsychological effects of treatment were investigated in 124 childhood cancer patients. Children were classified into groups on the basis of treatment modality and treatment status. All patients received systemic chemotherapy. Other treatment modalities included intrathecal chemotherapy and intrathecal chemotherapy plus central nervous system radiation therapy. Treatment status was determined by whether children were newly diagnosed patients in active treatment or long-term survivors of cancer. This classification resulted in five groups; group 1 (n = 29)--children with newly diagnosed disease who were receiving intrathecal chemotherapy; group 2 (n = 21)--children with newly diagnosed disease who were receiving systemic chemotherapy without central nervous system treatment; group 3 (n = 24)--long-term survivors who had received intrathecal chemotherapy; group 4 (n = 25)--long-term survivors who had received intrathecal chemotherapy plus cranial radiotherapy; and group 5 (n = 25)--long-term survivors who had received systemic chemotherapy only (no specific central nervous system treatment). Groups were compared by using multivariate analysis of variance on sets of neuropsychological test variables that represent major cognitive domains. Results of comparisons indicated significant group differences for most dependent-variable sets. Follow-up pairwise comparisons showed that the group of long-term survivors who had received intrathecal chemotherapy plus cranial radiotherapy consistently obtained lower test scores than the other four groups. These findings are consistent with results of previous studies, thus indicating that intrathecal chemotherapy plus cranial radiotherapy is associated with significant effects on neuropsychological performance. Comparisons among newly diagnosed and long-term groups of patients who did not receive cranial radiotherapy yielded null results on measures of higher-order cognitive functions. However, significant group differences were observed on measures of fine-motor and visual-motor skills; newly diagnosed groups obtained lower scores than the nonirradiated long-term survivor groups. Findings were attributed to chemotherapy-induced peripheral neuropathy that differentially affected the newly diagnosed groups.
研究了124例儿童癌症患者治疗可能产生的神经心理学影响。根据治疗方式和治疗状态将儿童分组。所有患者均接受全身化疗。其他治疗方式包括鞘内化疗以及鞘内化疗加中枢神经系统放射治疗。治疗状态根据儿童是处于积极治疗中的新诊断患者还是癌症长期幸存者来确定。这种分类产生了五组；第1组（n = 29）——新诊断疾病且正在接受鞘内化疗的儿童；第2组（n = 21）——新诊断疾病且正在接受无中枢神经系统治疗的全身化疗的儿童；第3组（n = 24）——接受过鞘内化疗的长期幸存者；第4组（n = 25）——接受过鞘内化疗加颅脑放疗的长期幸存者；第5组（n = 25）——仅接受过全身化疗（无特定中枢神经系统治疗）的长期幸存者。通过对代表主要认知领域的神经心理学测试变量集进行多变量方差分析来比较各组。比较结果表明，大多数因变量集存在显著的组间差异。后续的两两比较显示，接受过鞘内化疗加颅脑放疗的长期幸存者组的测试分数始终低于其他四组。这些发现与先前研究的结果一致，表明鞘内化疗加颅脑放疗对神经心理学表现有显著影响。在未接受颅脑放疗的新诊断患者组和长期患者组之间进行的高阶认知功能测量比较未得出结果。然而，在精细运动和视觉运动技能测量方面观察到显著的组间差异；新诊断组的得分低于未接受放疗的长期幸存者组。这些发现归因于化疗引起的周围神经病变对新诊断组产生了不同影响。
