Kleinberg L, Wallner K, Malkin M G
Dept. of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10021.
Int J Radiat Oncol Biol Phys. 1993 Apr 30;26(1):129-33. doi: 10.1016/0360-3016(93)90183-v.
To determine the long-term impact on function of treatment for primary cerebral gliomas, Karnofsky Performance Status, employment history, and memory function were used to evaluate the status of adults who are alive and disease-free more than 1 year after cranial irradiation.
Of 30 eligible adult patients, seventeen patients had anaplastic astrocytoma, seven had a glioblastoma, four had low grade astrocytoma, one had a mixed glioma, and one had an anaplastic oligodendroglioma. Sixteen patients received partial brain irradiation only, 12 had whole brain irradiation with a partial brain boost, and two had whole brain irradiation only. The total dose ranged from 54-66 Gy, with a fraction size of 1.7-2.0 Gy. Median follow-up was 3.5 years. Eighty-three percent of patients also received adjuvant chemotherapy.
Karnofsky Performance Status generally remained stable after the completion of irradiation. Mean Performance status was 84 at the end of irradiation and was unchanged at the time of last follow-up. The actuarial freedom from performance status decline after irradiation was 93% at 5 years. The performance status increased in two patients, both within several months of completing irradiation. Most patients (68%) returned to work after irradiation. Sixty-two percent remained at work 1 year later, and 58% were working at the time of last follow-up. No patient who did not return to work within 4 months of completing irradiation was able to work at a later date. All working patients were employed in a capacity similar to their pre-morbid position. Only one patient, with an intercurrent lung cancer, eventually developed deficits that limited self care.
Contrary to previously published reports, long-term glioma survivors maintained a relatively good performance status in the absence of recurrence and did not experience a progressive decline in neuropsychologic function after completion of cranial irradiation. A patient's function state at the completion of irradiation is a reliable predictor of long-term functional outcome in the absence of recurrence. Although the number of patients in each subgroup is small and no significant differences could be detected, patients treated with partial brain irradiation had a higher and more stable performance status, better memory function, and superior employment history.
为确定原发性脑胶质瘤治疗的长期功能影响，采用卡氏功能状态评分、就业史及记忆功能来评估在颅脑照射后存活且无疾病超过1年的成年患者的状况。
30例符合条件的成年患者中，17例为间变性星形细胞瘤，7例为胶质母细胞瘤，4例为低级别星形细胞瘤，1例为混合性胶质瘤，1例为间变性少突胶质细胞瘤。16例患者仅接受局部脑照射，12例接受全脑照射加局部脑推量照射，2例仅接受全脑照射。总剂量范围为54 - 66 Gy，分次剂量为1.7 - 2.0 Gy。中位随访时间为3.5年。83%的患者还接受了辅助化疗。
照射结束后，卡氏功能状态评分总体保持稳定。照射结束时平均功能状态评分为84分，末次随访时无变化。照射后5年功能状态评分无下降的精算概率为93%。2例患者的功能状态评分在照射结束后数月内有所提高。大多数患者（68%）照射后恢复工作。62%的患者在1年后仍在工作，末次随访时58%的患者仍在工作。在照射结束后4个月内未恢复工作的患者，之后均无法工作。所有恢复工作的患者从事的工作与病前岗位类似。仅1例并发肺癌的患者最终出现了限制自我护理的功能缺陷。
与先前发表的报告相反，长期胶质瘤幸存者在无复发的情况下保持了相对良好的功能状态，且在颅脑照射结束后神经心理功能并未出现进行性下降。照射结束时患者的功能状态是无复发情况下长期功能结局的可靠预测指标。尽管每个亚组的患者数量较少，未检测到显著差异，但接受局部脑照射的患者功能状态评分更高且更稳定，记忆功能更好，就业史更佳。
