Abstract
Background and Purpose
The objective of the current study was to evaluate the acute effects of cranial radiation therapy (CNS-RT) using different radiation doses (0, 1.8, 2, 3, ≥ 20 Gy) on cognitive function with special emphasis on memory. We assessed patients with and without intracranial tumors to distinguish between direct and indirect radiation effects on brain tissue.
Materials and Methods
Eighty-two patients were evaluated with neuropsychological testing before and acutely after radiotherapy (RT). Sixty-four patients received RT to the brain (55 with, 9 without intracranial tumor). Eighteen patients treated with RT to the breast served as controls.
Results
Patients with intracranial tumor demonstrated attention (19–38th percentile) and verbal memory scores (34–46th percentile) below the population average at baseline. The average Verbal Memory score was significantly different between patients with intracranial tumor and controls both at baseline (38th vs. 58th percentile) and after irradiation (27th vs. 52th percentile). Patients with preexisting peritumoral edema performed worse than patients without edema and controls. Radiation dose-related deficits were seen for working memory performance in patients with intracranial tumor.
Conclusion
Our data indicate no measurable impairment of cognitive functioning acutely after prophylactic cranial irradiation. Patients with intracranial tumor show a deterioration of almost all memory functions with a dose-dependent impairment in working memory. Patients with preexisting peritumoral brain edema show the strongest deterioration.
Zusammenfassung
Hintergrund und Ziel
Die vorliegende Arbeit untersucht Akuteffekte der kraniellen Strahlentherapie (ZNS-RT) nach unterschiedlichen Bestrahlungsdosen (0, 1.8, 2, 3, ≥ 20 Gy) auf die kognitive Funktion unter besonderer Berücksichtigung des verbalen Gedächtnisses. Wir haben Patienten mit und ohne Hirntumor untersucht, um zwischen direkten und indirekten Bestrahlungseffekten auf das Hirngewebe zu unterscheiden.
Patienten und Methodik
82 Patienten wurden vor und unmittelbar nach Beginn der Radiotherapie (RT) neuropsychologisch untersucht. 64 Patienten wurden am ZNS bestrahlt (55 mit, 9 ohne Hirntumor). 18 Patientinnen, die an der Mamma bestrahlt wurden, dienten als Kontrollgruppe.
Ergebnisse
Vor RT-Beginn lagen Aufmerksamkeitsleistungen (Prozentränge von 19–38) und verbale Gedächtnisleistungen (Prozentränge von 34–46) der Patienten mit Hirntumor unterhalb des Mittelwertes für die Normalbevölkerung (Tabellen 4, 5). Die durchschnittliche verbale Gedächtnisleistung der Patienten mit Hirntumor unterschied sich vor (Prozentrang 38 vs. 58) und nach RT (Prozentrang 27 vs. 52) signifikant von der der Kontrollgruppe (Abbildung 1). Patienten mit einem peritumoralen Hirnödem vor ZNS-RT zeigen schlechtere Leistungen als Patienten ohne Hirnödem und Kontrollpatienten (Abbildung 3). Bestrahlungsdosisabhängige Effekte wurden für das Arbeitsgedächtnis bei Patienten mit ZNS-Tumor beobachtet (Abbildung 2).
Schlussfolgerung
Unsere Daten zeigen keine messbaren kognitiven Beeinträchtigungen unmittelbar nach Beginn einer prophylaktischen Ganzhirnbestrahlung. Patienten mit Hirntumor zeigen eine Verschlechterung der verbalen Gedächtnisfunktionen und eine dosisabhängige Beeinträchtigung im Arbeitsgedächtnis. Patienten mit einem peritumoralen Hirnödem vor ZNS-RT zeigen die größten Veränderungen.
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Welzel, G., Fleckenstein, K., Mai, S.K. et al. Acute neurocognitive impairment during cranial radiation therapy in patients with intracranial tumors. Strahlenther Onkol 184, 647–654 (2008). https://doi.org/10.1007/s00066-008-1830-6
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DOI: https://doi.org/10.1007/s00066-008-1830-6