Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: long-term follow-up
Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: long-term follow-up
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DOI：
10.1016/s1474-4422(09)70204-2
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发表时间：
2009-09-01
期刊：
影响因子：
48
通讯作者：
Heimans, Jan J.
中科院分区：
文献类型：
--
作者：
Douw, Linda;Klein, Martin;Heimans, Jan J.
背景我们之前对195例低级别胶质瘤（LGG）患者的认知功能进行了研究，平均诊断时间为6年，结果表明肿瘤本身对认知功能的有害影响最大，而不是用于治疗的放疗;只有高剂量放疗（>2戈伊）导致认知功能显著恶化。本研究评估的放射学和认知异常的幸存者LGG在平均12年后首次diagnose.Methods谁有稳定的疾病，因为第一次评估的患者被邀请进行后续的认知评估（字母Aigit替代测试，概念转换测试，Stroop色词测试，视觉语言学习测试，记忆比较测试，和分类词流畅性）。计算6个认知领域（注意力、执行功能、言语记忆、工作记忆、精神功能和信息处理速度）的复合评分，以检测接受放疗的患者与未接受放疗的患者之间的差异。白质高信号和全球皮质萎缩进行了评估MRI scannes.Findings 65例患者完成了神经心理随访，平均12年（范围6-28年）。32例（49%）患者接受了放疗（3例分次剂量>2戈伊）。与未接受放疗的患者相比，接受放疗的患者在第二次随访时有更多影响注意功能的缺陷，无论分次剂量如何（-1.6 [SD 2.41 vs -0.1 [1.3]，p=0.003;平均差异1.4，95% CI 0.5-2-4）。接受放射治疗的患者在执行功能方面也表现较差（-2.0 [3.7] vs -0.5 [1.2]，p=0.03;平均差异1.5，0.2-2.9）和信息处理速度（-2.0 [3.7] vs -0.6 [1.5]，p=0.05;平均差异0.8，0.009-1.6]）。此外，注意力。在接受放疗的患者中，第一次和第二次评估之间的功能显著恶化（p=0.25）。总体而言，17例（53%）接受放疗的患者在18项神经心理学测试参数中至少有5项出现认知障碍，而4例（27%）未接受放疗的患者出现认知障碍。白质高信号和全球性皮质萎缩与更差的认知功能在几个domain.Interpretation长期生存的LGG谁没有放疗有稳定的放射学和认知状态。相比之下，接受放射治疗的低级别胶质瘤患者的注意力功能表现出进行性下降，即使是那些接受被认为是安全的剂量的患者（
Background Our previous study on cognitive functioning among 195 patients with low-grade glioma (LGG) a mean of 6 years after diagnosis suggested that the tumour itself, rather than the radiotherapy used to treat it, has the most deleterious effect on cognitive functioning; only high fraction dose radiotherapy (>2 Gy) resulted in significant added cognitive deterioration. The present study assesses the radiological and cognitive abnormalities in survivors of LGG at a mean of 12 years after first diagnosis.Methods Patients who have had stable disease since the first assessment were invited for follow-up cognitive assessment (letter-Aigit substitution test, concept shifting test, Stroop colour-word test, visual verbal learning test, memory comparison test, and categoric word fluency). Compound scores in six cognitive domains (attention, executive functioning, verbal memory, working memory, psychomotor functioning, and information processing speed) were calculated to detect differences between patients who had radiotherapy and patients who did not have radiotherapy. White-matter hyperintensities and global cortical atrophy were rated on MRI scans.Findings 65 patients completed neuropsychological follow-up at a mean of 12 years (range 6-28 years). 32 (49%) patients had received radiotherapy (three had fraction doses >2 Gy). The patients who had radiotherapy had more deficits that affected attentional functioning at the second follow-up, regardless of fraction dose, than those who did not have radiotherapy (-1.6 [SD 2.41 vs -0.1 [1.3], p=0.003; mean difference 1.4, 95% CI 0.5-2-4). The patients who had radiotherapy also did worse in measures of executive fucntioning (-2.0 [3.7] vs -0.5 [1.2], p=0.03; mean difference 1.5, 0.2-2.9) and information processing speed (-2.0 [3.7] vs -0.6 [1.5], p=0.05; mean difference 0.8, 0.009-1.6]) between the two assessments. Furthermore, attentional. functioning deteriorated significantly between the first and second assessments in patients who had radiotherapy (p=0.25). In total, 17 (53%) patients who had radiotherapy developed cognitive disabilities deficits in at least five of 18 neuropsychological test parameters compared with four (27%) patients who were radiotherapy naive. White-matter hyperintensities and global cortical atrophy were associated with worse cognitive functioning in several domains.Interpretation Long-term survivors of LGG who did not have radiotherapy had stable radiological and cognitive status. By contrast, patients with low-grade glioma who received radiotherapy showed a progressive decline in attentional functioning, even those who received fraction doses that are regarded as safe (