Shamsesfandabadi Parisa, Patel Arpeet, Liang Yun, Shepard Matthew J, Wegner Rodney E
Radiation Oncology department, Allegheny Health Network, Pittsburgh, PA, USA.
Drexel University College of Medicine, Philadelphia, PA, USA.
Cancer Manag Res. 2024 Aug 21;16:1043-1052. doi: 10.2147/CMAR.S441360. eCollection 2024.
Radiation therapy, a common treatment for central nervous system cancers, can negatively impact cognitive function, resulting in radiation-induced cognitive decline (RICD). RICD involves a decline in cognitive abilities such as memory and attention, likely due to damage to brain white matter, inflammation, and oxidative stress. The multifactorial nature of RICD poses challenges including different mechanisms of injury (neurogenesis, oxidative stress and neuroinflammation, dendritic structure alterations and vascular effects) and confounding factors like advanced age, and pre-existing conditions. Despite these challenges, several potential solutions exist. Neuroprotective agents like antioxidants can mitigate radiation damage, while cognitive rehabilitation techniques such as cognitive training and memory strategies improve cognitive function. Advanced imaging techniques like magnetic resonance imaging (MRI) help identify vulnerable brain areas, and proton therapy offers precise targeting of cancer cells, sparing healthy tissue. Multidisciplinary care teams are crucial for managing RICD's cognitive and psychological effects. Personalized medicine, using genetic and molecular data, can identify high-risk patients and tailor treatments accordingly. Emerging therapies, including stem cell therapy and regenerative medicine, offer hope for repairing or replacing damaged brain tissue. Addressing RICD is vital for cancer survivors, necessitating consideration of cognitive function and provision of appropriate support and resources for those experiencing cognitive decline.
放射治疗是中枢神经系统癌症的常见治疗方法，但会对认知功能产生负面影响，导致放射性认知功能下降（RICD）。RICD表现为记忆和注意力等认知能力下降，这可能是由于脑白质损伤、炎症和氧化应激所致。RICD的多因素性质带来了诸多挑战，包括不同的损伤机制（神经发生、氧化应激和神经炎症、树突结构改变和血管效应）以及诸如高龄和既有疾病等混杂因素。尽管存在这些挑战，但仍有几种潜在的解决方案。抗氧化剂等神经保护剂可以减轻辐射损伤，而认知训练和记忆策略等认知康复技术可以改善认知功能。磁共振成像（MRI）等先进成像技术有助于识别易受损伤的脑区，质子治疗能够精确靶向癌细胞，同时保护健康组织。多学科护理团队对于管理RICD的认知和心理影响至关重要。利用基因和分子数据的个性化医疗可以识别高危患者并据此调整治疗方案。包括干细胞治疗和再生医学在内的新兴疗法为修复或替换受损脑组织带来了希望。解决RICD问题对癌症幸存者至关重要，需要考虑认知功能，并为认知功能下降的患者提供适当的支持和资源。
