Roman D D, Sperduto P W
Department of Physical Medicine, University of Minnesota Hospital and Clinic, Minneapolis.
Int J Radiat Oncol Biol Phys. 1995 Feb 15;31(4):983-98. doi: 10.1016/0360-3016(94)00550-8.
Radiation is an invaluable therapeutic tool in the treatment of cancer, with well-established palliative and curative efficacy. As patient survival has improved, attention has focused on long-range treatment side effects. One such adverse effect, neuropsychological impairment, is incompletely understood. Much of the extant research has been directed at childhood leukemia survivors treated with low-dose whole-brain radiation. Less is known about the effects of high-dose focal or whole-brain radiation used in the treatment of brain lesions. This article reviews the scientific literature in this area, with greatest emphasis on methodologically rigorous studies. Research design considerations are discussed. Review findings suggest that low-dose whole-brain radiation (18 to 24 Gy) in children is associated with mild delayed IQ decline, with more substantial deficits occurring in children treated at a young age. A high incidence of learning disabilities and academic failure is observed in this population and may be caused by poor attention and memory rather than low intellectual level. Children who receive higher dose radiation for treatment of brain tumors experience more pronounced cognitive decline. At higher doses, whole-brain radiation, in particular, is linked to deleterious cognitive outcomes. Remarkably little is known about cognitive outcomes in irradiated adults. Preliminary findings indicate that certain cognitive functions, including memory, may be more vulnerable to decline than others. Suggestions for future research are proposed.
放射治疗是癌症治疗中一项非常重要的治疗手段，其姑息治疗和治愈效果已得到充分证实。随着患者生存率的提高，人们开始关注放射治疗的远期副作用。其中一种副作用，即神经心理损伤，目前还未被完全了解。现有的大部分研究都集中在接受低剂量全脑放射治疗的儿童白血病幸存者身上。对于用于治疗脑部病变的高剂量局部或全脑放射治疗的影响，人们了解得较少。本文回顾了该领域的科学文献，重点关注方法严谨的研究，并讨论了研究设计方面的考虑因素。综述结果表明，儿童接受低剂量全脑放射治疗（18至24 Gy）与轻度的智商延迟下降有关，年龄较小接受治疗的儿童出现的缺陷更为明显。在这一人群中观察到学习障碍和学业失败的发生率较高，这可能是由于注意力和记忆力差而非智力水平低所致。接受更高剂量放射治疗脑肿瘤的儿童会出现更明显的认知能力下降。特别是在高剂量时，全脑放射治疗与有害的认知结果有关。对于接受放射治疗的成年人的认知结果，人们了解得非常少。初步研究结果表明，某些认知功能，包括记忆力，可能比其他功能更容易衰退。本文还提出了对未来研究的建议。
