This systematic review explored the neurobiological mechanisms underlying the clinical time course of cancer-related cognitive impairment (CRCI) in breast cancer patients through the review of longitudinal neuroimaging studies. Before chemotherapy, results reported no evidence for neuropsychological, structural (gray matter) and brain perfusion changes. However, functional brain alterations were evident and revealed a frontoparietal hyperactivation during working memory tasks. Fatigue and number of days since surgery were the two suggested confounding factors. Acutely after chemotherapy, this review found no evidence for neuropsychological changes while suggesting a pattern of frontal structural, perfusion and functional brain abnormalities. These findings seemed to be dependent on age, menopausal status at baseline, and fMRI task performed. Years after chemotherapy, results revealed evidence of partial neuropsychological, structural, and functional brain recovery. Regarding brain abnormality, this review suggested that it may begin quite early in the disease course, be more prominent shortly after chemotherapy and partially recover over time. Several hypotheses underlying these changes were discussed. The present review also provided important information for developing a time-specific treatment and prevention strategies and for the consideration of functional neuroimaging as a relevant tool for CRCI diagnosis, clinical monitoring, and intervention studies. The findings also suggested the need to implement studies with longitudinal designs, including a pre-treatment assessment, since cross-sectional studies were not able to detect this pattern of recovery over time, supporting only the theory of brain abnormalities, in breast cancer survivors.

中文翻译：

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乳腺癌患者与癌症相关的认知障碍的发展轨迹：纵向神经影像学研究的系统评价。

该系统评价通过对纵向神经影像学研究的回顾，探讨了乳腺癌患者癌症相关认知障碍（CRCI）临床时程的神经生物学机制。化疗之前，结果报告没有神经心理学，结构（灰质）和脑灌注变化的证据。然而，功能性大脑改变是明显的，并揭示了工作记忆任务期间的额前额过度激活。疲劳和手术后天数是两个提示的混杂因素。化疗后不久，该评价未发现神经心理学改变的证据，同时提示了额叶结构，灌注和脑功能异常的模式。这些发现似乎取决于年龄，基线的绝经状态以及执行的fMRI任务。化疗多年后，结果显示出部分神经心理学，结构和功能性大脑恢复的证据。关于脑部异常，该评价表明它可能在疾病过程的早期开始，在化疗后不久就更加突出，并随着时间的推移部分恢复。讨论了这些变化背后的几种假设。本综述还为开发针对特定时间的治疗和预防策略以及考虑将功能性神经成像作为CRCI诊断，临床监测和干预研究的相关工具提供了重要信息。研究结果还表明，有必要采用纵向设计进行研究，包括进行治疗前评估，因为横断面研究无法随时间检测到这种恢复模式，