Читать книгу Intracranial Gliomas Part II - Adjuvant Therapy - Группа авторов - Страница 58

Typical acute side effects from cranial irradiation include hair loss, dry skin, erythema and fatigue. Fatigue of grade 3 and more is noted in less than 5% of patients. Changes in sense of smell and serous otitis may occur as well. Long-term risks include radiation necrosis, neurocognitive decline, and neuroendocrine dysfunction.

Radiation necrosis may occur several months to several years following radiation treatment, but clinically relevant necrosis is relatively uncommon. One prospective randomized trial in LGG reported that the 2-year risk of developing radiation necrosis of grade 3 and more is 2.5% at a dose of 50.4 Gy and 5% at a dose of 64.8 Gy [29]. Another study examined the existing cumulative data on necrosis and suggested a 5% risk at 5 years for a partial brain dose of 72 Gy [33].

There are scant data suggesting long-term neurocognitive toxicity in adults from partial brain irradiation with focal FRT [33]. Cognitive dysfunction may occur due to tumor progression [34] and it is unclear whether FRT increases the risk of cognitive dysfunction in cases without tumor progression. Cognitive function was stable in a subset of patients with LGG treated on a prospective protocol with either low- or high-dose irradiation [35]. In the RTOG 9402 study, patients were given FRT with or without chemotherapy; no longitudinal changes in cognition were noted in survivors [36]. However, as neurocognitive testing is moving forward and becomes more sophisticated, we may gain tools sensitive enough to detect subtle changes in cognitive function after irradiation of brain tumors [37].