NEUROPSYCHOLOGICAL EFFECTS OF CRANIAL RADIATION - CURRENT KNOWLEDGE AND FUTURE-DIRECTIONS
NEUROPSYCHOLOGICAL EFFECTS OF CRANIAL RADIATION - CURRENT KNOWLEDGE AND FUTURE-DIRECTIONS
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DOI：
10.1016/0360-3016(94)00550-8
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发表时间：
1995-02-15
影响因子：
7
通讯作者：
SPERDUTO, PW
中科院分区：
文献类型：
--
作者：
ROMAN, DD;SPERDUTO, PW
放射是治疗癌症的一种宝贵的治疗工具，具有公认的姑息和治疗效果。随着患者存活率的提高，人们开始关注长期治疗的副作用。其中一种副作用，神经心理损伤，还没有完全被理解。现存的许多研究都是针对接受低剂量全脑辐射治疗的儿童白血病幸存者。对于用于治疗脑损伤的高剂量局灶性或全脑辐射的影响，人们所知甚少。本文回顾了这一领域的科学文献，最强调的是方法论上的严谨研究。讨论了研究设计的考虑因素。回顾研究结果表明，儿童低剂量全脑辐射（18至24 Gy）与轻度迟发性智商下降有关，更严重的缺陷发生在幼年接受治疗的儿童身上。在这一人群中，学习障碍和学业失败的发生率很高，这可能是由于注意力和记忆力差而不是智力水平低造成的。接受高剂量辐射治疗脑肿瘤的儿童认知能力下降更为明显。在较高剂量下，全脑辐射尤其与有害的认知结果有关。值得注意的是，我们对受辐射成人的认知结果知之甚少。初步研究结果表明，某些认知功能，包括记忆，可能比其他功能更容易衰退。并对今后的研究提出了建议。
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.