基于不同部位评估脑转移癌患者全脑放疗后近期认知功能动态变化

目的 通过动态监测不同部位脑转移癌患者全脑放疗后认知功能变化,探讨全脑放疗对脑认知功能的影响及与颅内转移灶部位的关系.方法 选取行全脑放疗脑转移癌患者88例为研究对象,按照颅内病灶主要部位分为A1组(31例,小脑、脑干)、A2组(57例,额叶、颞叶),在放疗前1周、放疗后1~3个月采用简易精神状态量表(MMSE)、词汇流畅性试验(VFT)、数字广度试验(DS)评估患者总体认知功能.结果 放疗前1周A2组MMSE评分24~26分所占比例高于A1组,A2组MMSE、DS、VFT评分明显低于A1组(P<0.05);入组患者放疗后1个月内复查MRI,A1组总有效率为32.26%,A2组为70.18%,两组比较差异有统计学意义(Z=3.044,P=0.002);A1组患者放疗前与放疗后1~3个月MMSE无明显变化(P>0.05),A2组患者放疗后MMSE高于放疗前(P<0.05),且放疗后1~3个月有逐渐升高趋势.结论 全脑放疗对不同部位脑转移癌患者近期总体认知功能的影响不同,其中额叶、颞叶部位脑转移癌患者放疗后认知功能有明显改善,认知功能障碍可能与额叶、颞叶结构及功能改变相关.

Dynamic monitoring of cognitive function changes in patients with brain metastases after whole brain radiotherapy

Objective By dynamic monitoring of cognitive function changes in patients with brain metastases after whole brain radiotherapy, to investigate the correlation between the intracranial metastatic foci and effect of whole brain radiotherapy (WBRT) on brain cognitive function. Method A total of 88 patients with brain metastases who admitted WBRT were included in the analysis and were stratified by the site of intracranial lesions as group A1 (31 cases, cerebel-lum, brainstem), group A2 (57 cases, frontal lobe, temporal lobe). The overall cognitive function was assessed using the mini-mental state examination (MMSE) and vocabulary fluency test (VFT), digit span test (DS) 1 week before and 1 to 3 months after radiotherapy. Result The proportion of patients with MMSE score of 24 to 26 in group A2 was higher than that in the group A1 in 1 week before the radiotherapy, while the MMSE, DS, VET score in A2 group were significantly lower than that in A1 group (P<0.05);88 patients were administered with MRI 1 month after radiotherapy, the total re-sponse rate in A2 group was 70.18%, which was higher than that in the group A1 at 32.26%(Z=3.044, P=0.002);MMSE in A1 group before radiotherapy was similar with that in 1 to 3 months after radiotherapy (P>0.05);While the MMSE in A2 group was significantly higher than baseline (P<0.05), which increased gradually in 3 months after radiotherapy. Con-clusion The results show that whole brain radiotherapy differs in its influence on overall cognitive function in patients with different parts of brain metastases, and the cognitive function significantly improves after radiotherapy in patients with frontal and temporal lobe of brain metastases, and it is supposed that cognitive dysfunction may be associated with the structural and functional changes in frontal and temporal lobe.