Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: High-dose versus standard-dose chemotherapy
Impairment of cognitive function in women receiving adjuvant treatment for high-risk breast cancer: High-dose versus standard-dose chemotherapy
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DOI：
10.1093/jnci/90.3.210
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发表时间：
1998-02-04
期刊：
影响因子：
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通讯作者：
Rodenhuis, S
中科院分区：
文献类型：
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作者：
van Dam, FSAM;Schagen, SB;Rodenhuis, S
背景资料：尽管高剂量化疗作为许多癌症的治疗选择正在迅速被接受，但此类治疗的长期毒性作用令人担忧，认知缺陷（例如，记忆和注意力问题）在化疗后并不罕见，但尚未系统地记录。在这项研究中，我们评估了一组高危乳腺癌患者的认知缺陷患病率，这些患者被随机分配接受高剂量或标准剂量辅助化疗加他莫昔芬，我们调查了高剂量化疗是否比标准剂量化疗更损害认知功能，方法：认知功能通过一系列神经心理学测试进行评估，此外，患者还接受了关于认知问题、健康相关生活质量、焦虑和抑郁的访谈，将接受辅助全身治疗的患者的结果与未接受此类治疗的早期乳腺癌患者的结果进行比较（对照组），结果：研究人群包括34例接受高剂量化疗加他莫昔芬治疗的患者，36例接受标准剂量化疗加他莫昔芬治疗的患者，34例为对照组，所有患者完成最后一次非激素治疗的平均时间为2年，大剂量化疗组32%、标准剂量化疗组17%、对照组9%出现认知功能障碍，与对照组比较，接受高剂量化疗的患者出现认知障碍的风险似乎高出8.2倍（比值比; 95%置信区间[CI] = 1.8-37.7）;与接受标准剂量化疗的患者相比，结论：大剂量化疗对认知功能的损害大于标准剂量化疗，中枢神经系统毒性可能是大剂量化疗的剂量限制因素。
Background: Although high-dose chemotherapy is rapidly gaining acceptance as a treatment option for a number of cancers, the long-term toxic effects of such therapy are a concern, Cognitive deficits (e,g,, problems with memory and concentration) are not uncommon after chemotherapy, but they have not been documented systematically, In this study, we assessed the prevalence of cognitive deficits in a group of patients with high-risk breast cancer who were randomly assigned to receive either high-dose or standard-dose adjuvant chemotherapy plus tamoxifen, and we investigated whether high-dose chemotherapy impaired cognitive functioning more than standard-dose chemotherapy, Methods: Cognitive functioning was evaluated by use of a battery of neuropsychologic tests, In addition, patients were interviewed with regard to cognitive problems, health-related quality of life, anxiety, and depression, Results from patients who received adjuvant systemic therapy were compared with results from patients who had early stage breast cancer not treated with such therapy (control patients), Results: The study population consisted of 34 patients treated with high-dose chemotherapy plus tamoxifen, 36 patients treated with standard-dose chemotherapy plus tamoxifen, and 34 control patients, For all patients, the average time since the completion of last nonhormonal therapy was 2 years, Cognitive impairment was found in 32% of the patients treated with high-dose chemotherapy, in 17% of the patients treated with standard-dose chemotherapy, and in 9% of the control patients, In comparison with the control patients, patients treated with high-dose chemotherapy appeared to have an 8.2-times higher risk of cognitive impairment (odds ratio; 95% confidence interval [CI] = 1.8-37.7); in comparison with the patients who received standard-dose chemotherapy, this risk of impairment was 3.5-times higher (95% CI = 1.0-12.8), Conclusion: High-dose chemotherapy appears to impair cognitive functioning more than standard-dose chemotherapy, Central nervous system toxicity may be a dose-limiting factor in high-dose chemotherapy regimens.