Acute and Late Onset Cognitive Dysfunction Associated With Chemotherapy in Women With Breast Cancer
Acute and Late Onset Cognitive Dysfunction Associated With Chemotherapy in Women With Breast Cancer
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DOI：
10.1002/cncr.25098
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发表时间：
2010-07-15
期刊：
影响因子：
6.2
通讯作者：
Meyers, Christina A.
中科院分区：
文献类型：
--
作者：
Wefel, Jeffrey S.;Saleeba, Angele K.;Meyers, Christina A.
背景：越来越多的证据支持乳腺癌幸存者的认知功能障碍与标准剂量化疗相关。我们在一项前瞻性纵向随机3期治疗试验中确定了认知功能障碍的发生率、性质和慢性程度，该试验对接受5-氟尿嘧啶、多柔比星和环磷酰胺联合或不联合紫杉醇治疗的T1-3、NO-1、MO乳腺癌患者进行了治疗。方法：42例患者接受了神经心理学评估，包括认知，情绪和生活质量的措施。计划在化疗前、化疗期间和化疗后不久以及化疗完成后1年对患者进行评估。结果：化疗前，21%（9/42）的患者表现出认知功能障碍。在急性期，65%（37例中的24例）表现出认知能力下降。在长期评估中，61%（28例中的17例）在停止治疗后出现认知功能下降。在该组患者中，71%（12/17）的患者表现出从急性期开始的持续下降，值得注意的是，29%（5/17）的患者表现出新的延迟性认知下降。认知能力下降在学习和记忆、执行功能和处理速度方面最为常见。认知能力下降与情绪或其他测量的临床或人口统计学特征无关，但晚期下降可能与基线表现水平相关。结论：标准剂量全身化疗与化疗期间和化疗结束后不久的认知功能下降有关。此外，大部分患者发生迟发性认知功能障碍。这些发现与正在发展的转化动物研究机构一致，这些研究表明急性和延迟的脑结构变化以及与常见化疗药物（如5-氟尿嘧啶）相关的功能变化。Cancer 2010;116：3348-56. (C)2010美国癌症协会
BACKGROUND: Growing evidence supports cognitive dysfunction associated with standard dose chemotherapy in breast cancer survivors. We determined the incidence, nature, and chronicity of cognitive dysfunction in a prospective longitudinal randomized phase 3 treatment trial for patients with T1-3, NO-1, MO breast cancer receiving 5-fluorouracil, doxorubicin, and cyclophosphamide with or without paclitaxel. METHODS: Forty-two patients underwent a neuropsychological evaluation including measures of cognition, mood, and quality of life. Patients were scheduled to be assessed before chemotherapy, during and shortly after chemotherapy, and 1 year after completion of chemotherapy. RESULTS: Before chemotherapy, 21% (9 of 42) evidenced cognitive dysfunction. In the acute interval, 65% (24 of 37) demonstrated cognitive decline. At the long-term evaluation, 61% (17 of 28) evidenced cognitive decline after cessation of treatment. Within this group of patients, 71% (12 of 17) evidenced continuous decline from the acute interval, and, notably, 29% (5 of 17) evidenced new delayed cognitive decline. Cognitive decline was most common in the domains of learning and memory, executive function, and processing speed. Cognitive decline was not associated with mood or other measured clinical or demographic characteristics, but late decline may be associated with baseline level of performance. CONCLUSIONS: Standard dose systemic chemotherapy is associated with decline in cognitive function during and shortly after completion of chemotherapy. In addition, delayed cognitive dysfunction occurred in a large proportion of patients. These findings are consistent with a developing body of translational animal research demonstrating both acute and delayed structural brain changes as well as functional changes associated with common chemotherapeutic agents such as 5-flouorouracil. Cancer 2010;116:3348-56. (C) 2010 American Cancer Society.