不同部位脑转移癌全脑放疗后近期认知功能改变的研究

摘要

Objective To study if there was cognitive function impairment after whole-brain radiotherapy to metastases of different parts of the brain and the impairment differences.Methods Forty-seven patients with brain metastases(BM)were divided into two groups according to the lesion sites:31 cases were in group A (lesion main parts:frontal and/or temporal leaf),and 1 6 cases in group B (lesion main parts:the cerebellum and/or brain stem).Two groups of subjects were equal to the dose of whole brain radiotherapy,that was,2.0 Gy per day,5 times per week for a total dose of 40 Gy.Mini-Mental State Examination (MMSE)as overall cognitive function assessment tool,the cog-nitive function changes and differences between two groups after one months of radiotherapy were evaluated.Results 59.57%of the patients had MMSE scores of 27 or lower in 1 week before radiotherapy,and the overall cognitive function in group A and group B was significantly dif-ferent(P<0.05).MMSE scores were better in Group A before radiotherapy than those after radiotherapy,and the difference was statistically significant(P<0.05),while MMSE scores in Group B before and after radiotherapy had no statistically significant difference(P>0.05). Conclusion Changes in cognitive function at early stage is heterogeneous between different parts of the brain metastases after whole brain ra-diotherapy.Frontal or temporal lobe may be more associated with the occurrence of cognitive impairment which may be improved after WBRT.%目的：探讨不同部位脑转移癌经全脑放疗（WBRT）后近期认知功能改变及其差异性。方法47例脑转移癌患者按颅内病灶部位分组：A组（病灶主要部位：额叶、颞叶）31例，B组（病灶主要部位：小脑、脑干）16例。两组均行WBRT，2．0 Gy/次，5次/周，总剂量40 Gy。以简易精神状态检查量表（MMSE）作为总体认知功能评估工具，分别评价放疗前1周、放疗后1个月的认知功能。结果放疗前1周，59．57％的患者MMSE成绩＜27分，且A组总体认知功能低于B组，差异有统计学意义（P＜0．05）。A组放疗前后的MMSE成绩比较好转，差异有统计学意义（P＜0．05）；B组放疗前后的MMSE成绩差异无统计学意义（P ＞0．05）。结论不同部位的脑转移灶在WBRT后近期认知功能的改变不同，额、颞叶结构及功能的改变可能与认知障碍的发生相关，额、颞叶部位转移的患者因肿瘤而损害的认知功能放疗后可能会改善。