Academic Department of Neurosurgery, Evangelismos Hospital, Athens, Greece.
Academic Department of Neurosurgery, Evangelismos Hospital, Athens, Greece.
Radiother Oncol. 2021 Jul;160:202-211. doi: 10.1016/j.radonc.2021.04.023. Epub 2021 May 6.
Grade II gliomas are slow growing tumours that usually affect younger patients. The mainstream treatment modality at present is surgical. The role of radiation therapy in the management of grade II gliomas has been the subject of considerable debate. Radiation therapy has a proven potential to prolong progression free and overall survival in high-risk patients, but may also produce long-term cognitive deficits. Since grade II glioma patients are expected to live several years, retention of cognitive capacity and quality of life is an equally important endpoint as prolonging progression free survival. Our overarching goal is to critically review the available evidence on the possible neuropsychological effects of postoperative radiotherapy in adult grade II glioma patients. We performed a systematic literature search in Medline, Embase and Cochrane databases up to 1st of May 2020 for studies assessing the cognitive effects of radiation therapy on grade II glioma patients. Eleven studies meeting our inclusion criteria provide either negative or contradictory data regarding the cognitive domains affected, while major confounding variables remain incompletely addressed. The available evidence does not adequately support the notion that current radiation therapy protocols independently produce substantial cognitive decline in grade II glioma patients and therefore it would be premature to argue that radiation associated cognitive morbidity outweighs the benefit of prolonged survival. A large prospective study incorporating a full battery of neuropsychological testing, sufficiently long-term follow-up period and tight control of confounders is due to provide high quality data.
二级胶质瘤是生长缓慢的肿瘤，通常影响年轻患者。目前的主要治疗方法是手术。放射治疗在二级胶质瘤治疗中的作用一直是一个备受争议的话题。放射治疗已被证明具有延长高危患者无进展生存期和总生存期的潜力，但也可能导致长期认知缺陷。由于二级胶质瘤患者预计能存活数年，因此保持认知能力和生活质量与延长无进展生存期同样重要。我们的总体目标是批判性地回顾有关术后放疗对成人二级胶质瘤患者可能产生的神经心理学影响的现有证据。我们在 Medline、Embase 和 Cochrane 数据库中进行了系统的文献检索，检索时间截至 2020 年 5 月 1 日，以评估评估放射治疗对二级胶质瘤患者认知影响的研究。符合纳入标准的 11 项研究提供了关于受影响认知领域的阴性或矛盾数据，而主要混杂变量仍未得到充分解决。现有证据不足以支持当前的放射治疗方案会独立导致二级胶质瘤患者认知能力显著下降的观点，因此，认为放射相关认知发病率超过延长生存获益还为时过早。一项包含全面神经心理学测试、足够长的随访期和严格控制混杂因素的大型前瞻性研究将提供高质量的数据。
