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

Evaluation of neurocognitive and quality of life in patients treated with stereotactic radiotherapy and whole brain radiotherapy for brain metastases

目的探讨立体定向放射治疗(SRT)和全脑放射治疗(WBRT)对脑转移瘤患者神经认知功能和健康相关生活质量的影响。方法对收集的192例脑转移瘤患者,分别进行单纯WBRT、单纯SRT以及SRT+WBRT治疗,每组随机分为64例患者,分别进行神经认知功能和健康相关生活质量(HRQo L)的评价,神经认知功能共评价6个功能部分,HRQoL用QLQ-C30和BN20表进行共6个方面的评价。结果在神经认知功能方面,患者在WBRT、SRT、SRT+WBRT之后在视觉记忆、工作记忆、注意力、视觉构象能力方面均无显著性差异(P均>0.05),而在信息处理速度和执行功能方面SRT+WBRT优于单纯WBRT组和单纯SRT组,差异均有统计学意义(P均<0.05);KPS<90分患者与KPS≥90分患者在信息处理速度(P=0.0036)和执行功能(P=0.0024)方面差异具有统计学意义(P均<0.05),其他方面差异无统计学意义。在健康相关生活质量方面,患者在WBRT、SRT、SRT+WBRT之后在情感功能、角色功能、交流障碍、运动功能障碍方面均无显著性差异(P均>0.05),而在物理功能和认知功能方面SRT+WBRT优于单纯WBRT组和SRT组,差异均有统计学意义(P均<0.05);KPS<90分患者与KPS≥90分患者在物理功能(P=0.0016)和认知功能(P=0.0048)方面,差异具有统计学意义(P均<0.05),其他方面差异无统计学意义。结论立体定向放射治疗加全脑放射治疗对于提高患者的神经认知功能和生活质量方面有一定效果,可作为更好的治疗脑转移瘤的方式。

Objective To evaluate the impact of brain metastases and stereotactic radiotherapy（ SRT）and whole brain radiotherapy （WBRT）on neurocognitive functioning and health - related quality of life（HRQoL）. Methods Neurocognitive functioning and HRQoL of 192 patients with brain metastases were measured after three kinds of radiotherapy. Six cognitive domains were assessed. HRQoL was assessed with the European Organisation for Research and Treatment of Cancer（EORTC）QLQ - C30 and BN20 questionnaires. Results In terms of neurocogni-tive function,there was no significant difference in visual memory,working memory,attention,visual conformation capacity（ P ﹥ 0. 05）. There was significant difference in information processing speed and executive functioning（ P ﹤ 0. 05）between WBRT,SRT and SRT ＋ WBRT. The pa-tients with KPS ﹤ 90 compared with those with KPS≥90 in the information processing speed and executive function showed significant difference（ P ﹤ 0. 05）. In terms of HRQoL,there was no significant difference in emotional functioning,role functioning,motor dysfunction,communication deficits（ P ﹥ 0. 05）and significant difference in physical functioning and cognitive functioning（ P ﹤ 0. 05）between WBRT,SRT and SRT ＋WBRT;the patients with KPS ﹤ 90 compared with those with KPS≥90 inphysical functioning and cognitive functioning showed significant differ-ence（ P ﹤ 0. 05）. Conclusion Over time,SRT ＋ WBRT improved neurocognitive functioning and HRQoL of patients,suggesting that SRT ＋WBRT may be preferred for brain metastases.