Loga Karolina, Wojcik Bartosz, Stanislawek Anna, Papis-Ubych Anna, Kuncman Lukasz, Fijuth Jacek, Gottwald Leszek
Department of Teleradiotherapy, Copernicus Memorial Hospital, Lodz, Poland.
Department of Imaging Diagnostics, Copernicus Memorial Hospital, Lodz, Poland.
Rep Pract Oncol Radiother. 2024 Dec 4;29(5):558-565. doi: 10.5603/rpor.102617. eCollection 2024.
In small cell lung cancer (SCLC), limiting the radiation dose in the hippocampus area during preventive cranial irradiation (PCI) can reduce nerve injury and cognitive decline. This study was done to compare changes in cognitive functions between hippocampal-protected (3D-H) and non-hippocampal-protected (3D) patients during PCI.
the study group included 113 patients with SCLC qualified to PCI divided in two subgroups: 3D-H (n = 74) and 3D (n = 39). Two diagnostic and screening tests, Mini-Mental State Examination (MMSE) Short Scale and Montreal Cognitive Assessment (MoCA) Scale, have been applied before the start of irradiation, immediately after and 3 months after PCI.
The doses delivered to the volume of the left and right hippocampus were similar and amounted to 12.00 Gy and 12.05 Gy, respectively. There were no differences between 3D-H and 3D groups in the MoCA and MMSE tests at any time point. In both groups the values in MoCA and MMSE scales differed between time points I, II and III. The patients in the 3D-H group were less likely than patients in 3D group to experience significant cognitive decline on the MoCA scale (p = 0.003), but not on the MMSE scale (p = 0.103).
Following PCI, SCLC patients experience significant cognitive decline, even when the radiation dose in the hippocampal area is reduced. This trend continues for at least 3 months following the PCI. In hippocampal-protected patients significant cognitive decline assessed on the MoCA scale is less common than in non-hippocampal-protected patients.
在小细胞肺癌（SCLC）中，预防性颅脑照射（PCI）期间限制海马区的辐射剂量可减少神经损伤和认知功能下降。本研究旨在比较PCI期间海马保护组（3D-H）和非海马保护组（3D）患者认知功能的变化。
研究组包括113例符合PCI条件的SCLC患者，分为两个亚组：3D-H组（n = 74）和3D组（n = 39）。在放疗开始前、放疗结束后即刻以及PCI后3个月，应用了两项诊断和筛查测试，即简易精神状态检查表（MMSE）简表和蒙特利尔认知评估（MoCA）量表。
左右海马体积所接受的剂量相似，分别为12.00 Gy和12.05 Gy。在任何时间点，3D-H组和3D组在MoCA和MMSE测试中均无差异。在两组中，MoCA和MMSE量表在时间点I、II和III之间的值均有所不同。3D-H组患者在MoCA量表上出现显著认知功能下降的可能性低于3D组患者（p = 0.003），但在MMSE量表上无差异（p = 0.103）。
PCI后，SCLC患者即使海马区辐射剂量降低，仍会出现显著的认知功能下降。这种趋势在PCI后至少持续3个月。在海马保护组患者中，通过MoCA量表评估的显著认知功能下降比非海马保护组患者少见。
