Abstract:【Objective】 To explore the effect of whole brain radiotherapy on the cognitive function and prospective memory in patients with brain metastases.【Methods】 A total of 100 patients underwent whole brain radiotherapy for brain metastases(WBRT) admitted in the hospital from April 2010 to May 2015 were selected. In 1 week before the whole brain radiotherapy, 1 week and 1~6 months after radiotherapy, the overall cognitive function included mini-mental state Examination (MMSE), Vocabulary fluency test (VFT), digit span test (DS) and the prospective memory including event-based prospective memory (EBPM) and event-based prospective memory (TBPM ) were assessed and compared.【Results】 One week after the radiotherapy, MMSE, DS, VFT and EBPM were all significantly lower than those before radiotherapy , and the difference was statistically significant (t=3.033,11.294, 5.055, 3.966,P<0.05); 1 week after radiotherapy, TBPM had no significant change after radiotherapy(P>0.05); MMSE and EBPM were significantly lower than the baseline in patients without neurological symptoms before radiotherapy(P<0.05), 4 months after radiotherapy , their MMSE and EBPM went to valley, and then gradually picked up, Patients with neurological symptoms before radiotherapy (MMSE≤ 26), MMSE and EBPM were significantly higher than the baseline level after radiotherapy (P<0.05), 4 months after radiotherapy, they went to the peak, then gradually decreased.【Conclusion】Whole brain radiotherapy has a certain effect on the overall cognitive function and prospective memory in patients with brain metastases, especially on those event-based prospective memory . The cognitive impairment was more significant in 4 months after radiotherapy. Patients of metastatic brain cancer with neurological system symptoms before radiotherapy may meet single separation phenomenon in the change of cognitive function after radiotherapy.
胡潺潺;连相尧;王锐. 全脑放疗对脑转移癌患者认知功能及前瞻性记忆的影响[J]. 医学临床研究, 2016, 33(10): 1888-1891.
HU Chan-chan, LIAN Xiang-rao, WANG Rui. Effect of Whole Brain Radiotherapy on Cognitive Function and Prospective Memory in Patients with Brain Metastases. JOURNAL OF CLINICAL RESEARCH, 2016, 33(10): 1888-1891.
[1] Chukwueke U, Batchelor T, Brastianos P. Management of brain metastases in patients with melanoma[J].J Oncol Pract,2016,12(6):536-542. [2] Murrell DH, Zarghami N, Jensen MD,et al. Evaluating changes to blood-brain barrier integrity in brain metastasis over time and after radiation treatment[J].Transl Oncol,2016,9(3):219-227. [3] Vernon J, Andruszkiewicz N, Schneider L, et al. Comprehensive clinical staging for resectable lung cancer: Clinico-pathological correlations and the role of brain MRI[J].J Thorac Oncol,2016,11(11):1970-1975. [4] Ma W, Li N, An Y, et al. Effect of Temozolomide and radiotherapy on brain metastatic tumor: a systematic review and meta-analysis[J].World Neurosurg,2016,92:197-205. [5] Pham A, Yondorf MZ, Parashar B, et al. Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial [J].J Neurooncol,2016,127(1):63-71. [6] Dye NB, Gondi V, Mehta MP. Strategies for preservation of memory function inpatients with brain metastases[J].Chin Clin Oncol(Engl),2015,4(2):24. [7] Savitz ST, Chen RC, Sher DJ. Cost-effectiveness analysis of neurocognitive-sparing treatments for brain metastases[J].Cancer,2015, 121(23):4231-4239. [8] Onodera S, Aoyama H, Tha KK, et al. The value of 4-month neurocognitive function as an endpoint in brain metastases trials[J].J Neurooncol,2014,120(2):311-319. [9] McDaniel MA, Einstein GO. The neuropsychology of prospective memory in normal aging: a componential approach[J].Neuropsychologia,2011,49(8):2147-2155. [10] Prabhu RS, Won M, Shaw EG, et al. Effect of the addition of chemotherapy to radiotherapy on cognitive function in patients with low-grade glioma: secondary analysis of RTOG 98-02[J].J Clin Oncol,2014,32(6):535-541. [11] 程怀东,李文,杨俊,等.脑转移癌全脑放疗对患者前瞻性记忆的影响[J].中华肿瘤防治杂志,2015,22(24):1911-1913. [12] Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)[J].Eur J Cancer,2009,45(2):228-247. [13] Brem S, Meyers CA, Palmer G, et al. Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers[J]. Cancer,2013,119(21):3830-3838. [14] Brown PD, Pugh S, Laack NN, et al. Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized,double-blind, placebo-controlled trial[J]. Neurol Oncol,2013,15(10):1429-1437. [15] 董标,李薇,王尚虎,等.脑转移癌全脑放疗相关认知功能损害[J].安徽医科大学学报,2014,49(10):1475-1478. [16] 董标,程怀东,陈振东,等.脑转移癌放疗后患者认知功能损害的研究进展[J].临床肿瘤学杂志,2013,18(6):565-570. [17] 汪步海,李颖,刘丽琴,等.应用海马保护技术预防全脑放疗患者认知功能障碍研究[J].中华肿瘤防治杂志,2015,22(18):1470-1474. [18] 胡晓菲,唐菲.脑转移癌全脑放疗相关认知功能损害的临床研究[J].现代肿瘤医学,2015,23(16):2279-2281. [19] 张菲菲,程怀东,王年飞,等.不同部位脑转移癌全脑放疗后近期认知功能改变的研究[J].安徽医学,2014,35(6):717-720. [20] Shaw MG, Ball DL. Treatment of brain metastases in lung cancer: strategies to avoid/reduce late complications of whole brain radiation therapy[J].Curr Treat Options Oncol,2013,14(4):553-567. [21] McDuff SG, Taich ZJ, Lawson JD, et al.Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases[J].J Neurol Neurosurg Psychiatry,2013,84(12):1384-1391. [22] 董标,解佳奇,程怀东,等.脑转移瘤放疗相关认知损害[J].安徽医药,2013,17(11):1905-1908. [23] Tallet AV, Azria D, Barlesi F, et al. Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment[J].Radiat Oncol,2012,7(1):77.