减轻脑转移瘤中辐射引起的认知毒性:问题多于答案。

IF 3.7 Q1 CLINICAL NEUROLOGY Neuro-oncology advances Pub Date : 2024-08-07 eCollection Date: 2024-01-01 DOI:10.1093/noajnl/vdae137
Marta Simó, Antoni Rodríguez-Fornells, Valentín Navarro, Arturo Navarro-Martín, Ernest Nadal, Jordi Bruna
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引用次数: 0

摘要

先进的全身疗法和颅脑放射技术的出现大大改善了多发性脑转移(BM)癌症患者的治疗效果,使长期存活的患者人数大幅增加。在这种情况下,辐射诱导的认知毒性(RICT)的增加变得越来越重要。在这篇重要的叙述性综述中,我们探讨了旨在减轻 RICT 的临床试验中出现的争议。我们深入探讨了美金刚、BM 治疗期间或预防性海马回避照射等干预措施,以及立体定向放射手术 (SRS) 的认知安全性评估。我们的研究重点延伸到最近的神经科学研究成果,强调不仅要保留海马皮质,还要保留参与神经动态网络的其他皮质区域,以及它们在编码新记忆中的复杂作用。尽管治疗取得了进展,但有效管理多发性骨髓瘤患者以及确定放射治疗和全身治疗的最佳时机和整合仍是需要进一步阐明的领域。未来还需要进行试验,以确定最佳适应症并确保 SRS 的安全性。此外,新的系统疗法的影响以及延迟照射对认知功能的潜在影响也需要解决。包容性试验设计包括多种脑梗塞患者,并考虑到不同的治疗方案,这对于推进管理 RICT 和治疗脑梗塞患者的有效策略至关重要。
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Mitigating radiation-induced cognitive toxicity in brain metastases: More questions than answers.

The emergence of advanced systemic therapies added to the use of cranial radiation techniques has significantly improved outcomes for cancer patients with multiple brain metastases (BM), leading to a considerable increase in long-term survivors. In this context, the rise of radiation-induced cognitive toxicity (RICT) has become increasingly relevant. In this critical narrative review, we address the controversies arising from clinical trials aimed at mitigating RICT. We thoroughly examine interventions such as memantine, hippocampal avoidance irradiation during BM treatment or in a prophylactic setting, and the assessment of cognitive safety in stereotactic radiosurgery (SRS). Our focus extends to recent neuroscience research findings, emphasizing the importance of preserving not only the hippocampal cortex but also other cortical regions involved in neural dynamic networks and their intricate role in encoding new memories. Despite treatment advancements, effectively managing patients with multiple BM and determining the optimal timing and integration of radiation and systemic treatments remain areas requiring further elucidation. Future trials are required to delineate optimal indications and ensure SRS safety. Additionally, the impact of new systemic therapies and the potential effects of delaying irradiation on cognitive functioning also need to be addressed. Inclusive trial designs, encompassing patients with multiple BM and accounting for diverse treatment scenarios, are essential for advancing effective strategies in managing RICT and the treatment of BM patients.

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CiteScore
6.20
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