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Neurobehavioral
sequelae of cranial irradiation in adults: a review of
radiation-induced encephalopathy
Crossen
JR, Garwood D, Glatstein E, Neuwelt EA
Department
of Medical Psychology, Oregon Health Sciences University, Portland
97201.
Purpose.
To examine behavioral dimensions of treatment outcomes for patients
receiving cranial irradiation.
Radiation
encephalopathy is one of these and refers to significant cognitive and
emotional dysfunction following radiation therapy to the brain.
Issues
of definition, estimated incidence, pathophysiologic mechanisms, and
recommended research designs are reviewed in relationship to
functional neurobehavioral outcomes.
Patients
and Methods.
Twenty-nine studies of adults receiving therapeutic cranial
irradiation (TCI) involving 748 patients and 18 studies of
prophylactic cranial irradiation (PCI) involving 368 patients are
reviewed.
Assessment
of patient outcomes are summarized for research published since 1980,
with specific attention to adverse changes in cognitive and emotional
functioning.
Results.
Analyses revealed that 213 TCI patients and 100 PCI patients showed
encephalopathy attributed to radiation.
Manifestations
of the late delayed effects of radiotherapy on brain function are
related to patient age, total dose of irradiation, fraction sizes, and
timing of chemotherapy.
Radiation
encephalopathy appears to be more common than the pathologic tissue
injury of radiation necrosis.
Accurate
diagnosis of these neurobehavioral sequelae can require follow-up over
a period of years with sensitive assessment procedures.
Conclusions.
It is likely that the true incidence of treatment-related side effects
of cranial irradiation in adults who survive more than 6 months
without brain tumor growth or recurrence has been significantly
underestimated.
Research
designs that include formal neuropsychologic assessment in conjunction
with other neurodiagnostic tests can provide more comprehensive
evaluation of long-term neurobehavioral outcomes.
PMID:
8120563 [PubMed - indexed for MEDLINE]
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