立体定向放射治疗对脑转移瘤患者短期神经认知功能及生活质量的影响

Effect of Stereotactic Radiotherapy on Short-Term Neurocognitive Function and Quality of Life in Patients with Brain Metastases

摘要: 目的：研究立体定向放射治疗(stereotactic radiotherapy, SRT)对脑转移瘤患者短期神经认知功能(neurocognitive function, NCF)及生活质量(quality of life, QoL)的影响。方法：以2019年1月~2020年3月在青岛市中心医院收治的行SRT的50例脑转移瘤患者为观察对象，依照患者放疗前有无神经系统症状分有神经症状组和无神经症状组，以简明精神状态量表(MMSE)为认知评估工具，日常生活能力量表(ADLS)为生活质量评估工具。分别于放疗前1周内、放疗结束时和放疗结束后3个月时行MMSE和ADLS评估，比较两组患者MMSE和ADLS分值的变化，分析SRT对脑转移瘤患者短期NCF和QoL的影响。结果有神经症状组SRT治疗前后MMSE结果比较：放疗结束时与放疗前1周比较(t = 10.25, P < 0.05)；放疗结束后3个月与放疗前1周比较(t = 18.38, P < 0.05)；放疗结束后3个月与放疗结束时比较(t = 13.60, P < 0.05)；差异均有统计学意义。无神经症状组SRT治疗前后MMSE测试结果比较：放疗结束时与放疗前1周比较(t = 0.44, P > 0.05)；放疗结束后3个月与放疗前1周比较(t = 1.85, P > 0.05)；放疗结束后3个月与放疗结束时比较(t = 1.11, P > 0.05)；差异均无统计学意义。有神经症状组SRT治疗前后ADL测试结果比较：放疗结束时与放疗前1周比较(t = 14.73, P < 0.05)；放疗结束后3个月与放疗前1周比较(t = 10.11, P < 0.05)；放疗结束后3个月与放疗结束时比较(t = 5.48, P < 0.05)；差异均有统计学意义。无神经症状组SRT治疗前后ADL测试结果比较：放疗结束时与放疗前1周比较(t = 2.06, P > 0.05)；放疗结束后3个月与放疗前1周比较(t = 1.16, P > 0.05)；放疗结束后3个月与放疗结束时比较(t = 1.01, P > 0.05)；差异均无统计学意义。经过SRT前后对比，两组患者脑转移瘤的缓解率[完全缓解(CR) + 部分缓解(PR)]分别为77.8% (21/27)和82.6% (19/23)，其他均为疾病稳定(SD)状态，未见明显进展(PD)病例。结论SRT能够改善有神经症状的脑转移瘤患者的短期NCF和QoL，对于无神经症状脑转移瘤患者的短期NCF和QoL没有明显影响。

Abstract: Objective: To study the effect of stereotactic radiotherapy (SRT) on short-term neurocognitive function (NCF) and quality of life (QoL) in patients with brain metastases. Methods: Fifty patients with brain metastases undergoing SRT who were admitted to Qingdao Central Hospital from January 2019 to March 2020 were taken as observation objects. According to whether the patients had neurological symptoms before radiotherapy, they were divided into neurological symptoms group and non-neural symptoms group, using the Concise Mental State Scale (MMSE) as a cognitive assessment tool, and the Daily Life Ability Scale (ADLS) as a quality of life assessment tool. MMSE and ADLS were assessed within 1 week before radiotherapy, at the end of radiotherapy, and 3 months after radiotherapy. The changes in MMSE and ADLS scores of the two groups were compared, and the effect of SRT on short-term NCF and QoL in patients with brain metastases was analyzed. Results: Comparison of MMSE results before and after SRT treatment in the neurological symptom group: comparison between the end of radiotherapy and 1 week before radiotherapy (t = 10.25, P < 0.05); comparison of 3 months after the end of radiotherapy and 1 week before radiotherapy (t = 18.38, P < 0.05); 3 months after the end of radiotherapy compared with the end of radiotherapy (t = 13.60, P < 0.05); the differences were statistically significant. Comparison of MMSE test results before and after SRT treatment in the asymptomatic group: comparison between the end of radiotherapy and 1 week before radiotherapy (t = 0.44, P > 0.05); comparison of 3 months after the end of radiotherapy and 1 week before radiotherapy (t = 1.85, P > 0.05); 3 months after the end of radiotherapy compared with the end of radiotherapy (t = 1.11, P > 0.05); the difference was not statistically significant. Comparison of ADL test results before and after SRT treatment in the neurological symptom group: comparison between the end of radiotherapy and 1 week before radiotherapy (t = 14.73, P < 0.05); comparison of 3 months after the end of radiotherapy and 1 week before radiotherapy (t = 10.11, P < 0.05); 3 months after the end of radiotherapy compared with the end of radiotherapy (t = 5.48, P < 0.05); the differences were statistically significant. Comparison of ADL test results before and after SRT treatment in the asymptomatic group, at the end of radiotherapy and 1 week before radiotherapy (t = 2.06, P > 0.05); 3 months after the end of radiotherapy and 1 week before radiotherapy (t = 1.16, P > 0.05); 3 months after the end of radiotherapy compared with the end of radiotherapy (t = 1.01, P > 0.05); the difference was not statistically significant. After comparison before and after SRT, the remission rate of the two groups of patients with brain metastases [complete remission (CR) + partial remission (PR)] were 77.8% (21/27) and 82.6% (19/23), and the rest were stable disease (SD) status, no obvious progress (PD) cases. Conclusion: SRT can improve the short-term NCF and QoL of patients with brain metastases with neurological symptoms, but has no obvious effect on the short-term NCF and QoL of patients with brain metastases without neurological symptoms.