立体定向放射治疗脑转移瘤对患者近期神经认知功能及日常生活活动能力的影响
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摘要
目的探讨立体定向放射治疗(SRT)脑转移瘤对患者近期神经认知功能(NCF)及日常生活活动能力(ADL)的影响。方法以SRT治疗的48例脑转移瘤患者为研究对象,分有神经症状组和无神经症状组,分别于放疗前1周内、放疗结束时和放疗结束后3个月时检测患者的简易精神状态评价量表(MMSE)和ADL分值,比较两组患者放疗前1周内、放疗结束时和放疗结束后3个月时的MMSE和ADL分值的变化,分析SRT治疗脑转移瘤对患者近期NCF和ADL的影响。结果在SRT治疗后,在无神经症状组中,放疗结束时、放疗结束后3个月时的MMSE和ADL分值无明显下降,分别与放疗前1周时的MMSE分值比较,差异均无统计学意义(P> 0. 05)。在有神经症状组中,放疗结束时和放疗结束后3个月时患者的MMSE分值和ADL分值都较放疗前1周内时高,差异均有统计学意义(P <0. 05)。经过治疗前后对比,两组患者脑转移病灶缓解率[完全缓解(CR)+部分缓解(PR)]分别为84. 6%(22/26)和86. 3%(19/22),其余病例均为疾病稳定(SD),未见明显进展病例。在有神经症状组中,放疗前后疗效达CR的患者MMSE和ADL评分比疗效为PR的患者提高更明显,在无神经症状组中,则未发现疗效与MMSE和ADL评分有明显相关性。结论 SRT治疗可改善有神经症状脑转移瘤患者的近期NCF和ADL。对无神经症状脑转移瘤患者的近期NCF和ADL无重大影响。
Objective To investigate the early effects of stereotactic radiotherapy( SRT) on neurocognitive function( NCF) and activities of daily living( ADL) in patients with brain metastases. Methods Forty-eight patients with brain metastases treated by SRT were divided into two groups,neurological symptoms group and non-neurological symptoms group. Mini Mental State Scale( MMSE) and Activities of daily living scale( ADL) were used to evaluate NCF and ADL. The scores of MMSE and ADL were evaluated 1 week before SRT,at the end of SRT and three months after SRT.The changes of the scores in two groups were analyzed before and after radiotherapy to evaluate the early effects of SRT on NCF and ADL in patients with brain metastases. Results In non-neurological symptoms group,there was no significant decrease in scores of MMSE and ADL after SRT comparing with the scores before SRT. In neurological symptoms group,the scores after SRT was significantly higher than those before SRT( P < 0. 05). Conclusion SRT can improve the NCF and ADL in patients with neurological symptoms,but not affect the NCF and ADL in patients without neurological symptoms.
Objective To investigate the early effects of stereotactic radiotherapy( SRT) on neurocognitive function( NCF) and activities of daily living( ADL) in patients with brain metastases. Methods Forty-eight patients with brain metastases treated by SRT were divided into two groups,neurological symptoms group and non-neurological symptoms group. Mini Mental State Scale( MMSE) and Activities of daily living scale( ADL) were used to evaluate NCF and ADL. The scores of MMSE and ADL were evaluated 1 week before SRT,at the end of SRT and three months after SRT.The changes of the scores in two groups were analyzed before and after radiotherapy to evaluate the early effects of SRT on NCF and ADL in patients with brain metastases. Results In non-neurological symptoms group,there was no significant decrease in scores of MMSE and ADL after SRT comparing with the scores before SRT. In neurological symptoms group,the scores after SRT was significantly higher than those before SRT( P < 0. 05). Conclusion SRT can improve the NCF and ADL in patients with neurological symptoms,but not affect the NCF and ADL in patients without neurological symptoms.
引文
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[2]石远凯,孙燕,于金明.中国肺癌脑转移诊治专家共识(2017年版)[J].中国肺癌杂志,2017,20(1):1-12.
[3]谭志彬,陈谦学.立体定向放疗联合与不联合全脑放疗治疗脑转移瘤效果的Meta分析[J].中国医药导报,2015,12(26):90-95.
[4]王明龙.立体定向放射治疗联合全脑放射治疗脑转移瘤对患者神经认知功能和生活质量的影响[J].现代诊断与治疗,2018,29(3):439-440.
[5]张春满,郑云峰,米娟.立体定向放射治疗和全脑放射治疗脑转移瘤对患者神经认知功能和健康相关生活质量的影响分析[J].临床和实验医学杂志,2016,15(15):1514-1517.
[6]赖名耀,李娟,洪伟平,等.放射治疗损伤海马组织导致认知功能障碍的研究进展[J].临床神经病学杂志,2016,29(1):69-70.
[7]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.
[8]刘佳,舒忠琴,沙莎.海马保护技术对脑部放疗患者认知功能水平的影响临床研究[J].基层医学论坛,2018,22(7):907-908.
[9]Nakazaki K,Kano H. Evaluation of mini-mental status examination score after gamma knife radiosurgery as the first radiation treatment for brain metastases[J]. J Neurooncol,2013,112(3):421-425.
[10]Aoyama H,Tago M,Kato N,et al. Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone[J]. Int J Radiat Oncol Biol Phys,2007,68(5):1388-1395.
[11]Aoyama H,Shirato H,Tago M,et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases:a randomized controlled trial[J]. JAMA,2006,295(21):2483-2491.
[12]Li J,Bentzen SM. Relationship between neurocognitive function and quality of life after whole-brain radiotherapy in patients with brain metastasis[J]. Int J Radiat Oncol Boil Physics,2008,71(1):64-70.
[13]Soffietti R,Kocher M,Abacioglu UM,et al. A European Organisation for Research and Treatment of Cancer phaseⅢtrial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery:quality-of-life[J]. J Clin Oncol,2012,31(1):65-72.