Kognitivní toxicita indukovaná radioterapií v éře precizní onkologie – od patofyziologie ke strategiím omezení toxicity

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Autoři: C. C. Mirestean ^1,2; R. I. Iancu ^3,4; D. T. Iancu ^3,5
Působiště autorů: University of Medicine and Pharmacy of Craiova, Craiova, Romania ¹; Railways Clinical Hospital, Iasi, Romania ²; “Gr. T. Popa” University of Medicine and Pharmacy, Iasi, Romania ³; “St. Spiridon” Emergency Hospital, Iasi, Romania ⁴; Regional Institute of Oncology, Iasi, Romania ⁵
Vyšlo v časopise: Cesk Slov Neurol N 2023; 86(5): 322-326
Kategorie: Přehledný referát
doi: https://doi.org/10.48095/cccsnn2023322

Souhrn

Radioterapie je jedným ze základních složek léčby pacientů s intrakraniálními metastázami. Součástí nechirurgické léčby mozkových metastáz jsou celomozkové ozáření (whole brain radiotherapy – WBRT) a také stereotaktická radiochirurgie. V éře pokroku onkologické léčby s implikacemi pro dlouhodobé přežití pacientů je diskutovaným tématem toxicita těchto léčebných postupů, u které nemůžeme přehlédnout kognitivní poruchy. Mechanizmů, na jejichž základě kognitivní poruchy vznikají, je několik a jsou stále předmětem výzkumu. Zaměřujeme se na patofyziologické elementy, které se podílí na kognitivních poruchách, a na strategie, jakými jsou hipokampus šetřící (hippocampal avoidance; HA) WBRT pro kandidáty na cílenou léčbu s různými histologickými typy nádorů, která přechází hematoencefalickou bariéru. I když je léčba HA-WBRT plus memantinem jakožto standard stále předmětem diskuzí, v případech mnohočetných mozkových metastáz nebo metastáz, u kterých není vhodná cílená radioterapie, a u pacientů s očekávaným přežitím > 4 měsíce je nutné aplikovat strategii pro prevence poruch kognitivních funkcí. V budoucnu musí být do analýz a studií zařazeny nové studie, které zhodnotí kognitivní funkce u pacientů s dlouhodobým přežitím, ale také další faktory, jako je počet a objem mozkových metastáz, jejich intrakraniální a extrakraniální lokalizace a efekt moderních onkologických terapií.

Klíčová slova:

demence – kognitivní porucha – mozkové metastazy – celomozkové ozáření – šetření hippokampu – memantin

Zdroje

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