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Cognitive function after concurrent temozolomide-based chemoradiation therapy in low-grade gliomas

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Abstract

Purpose

We sought to evaluate the effects of concurrent temozolomide-based chemoradiation therapy on neurocognitive function in patients with low-grade glioma (LGG).

Materials/methods

We included adult patients with LGG who were treated postoperatively with radiotherapy (RT) with concurrent and adjuvant temozolomide (TMZ). Patients were evaluated with comprehensive psychometric tests at baseline (prior to RT + TMZ) and at various time intervals following RT + TMZ. Baseline cognitive performance was analyzed by sex, age, education history, history of seizures, IDH mutation status, and 1p/19q codeletion status. Changes in neurocognitive performance were evaluated over time.

Results

Thirty-seven LGG patients (mean age 43.6, 59.5% male) had baseline neurocognitive evaluation. Patients with an age > 40 years old at diagnosis and those with an education > 16 years demonstrated superior baseline verbal memory as assessed by HVLT. No other cognitive domains showed differences when stratified by the variables mentioned above.

A total of 22 LGG patients had baseline and post RT + TMZ neurocognitive evaluation. Overall, patients showed no statistical difference between group mean test scores prior to and following RT + TMZ on all psychometric measures (with the exception of HVLT Discrimination).

Conclusion

Cognitive function remained stable following RT + TMZ in LGG patients evaluated prospectively up to 2 years. The anticipated analysis of RTOG 0424 will provide valuable neurocognitive outcomes specifically for high risk LGG patients treated with RT + TMZ.

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Data availability

Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

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Funding

The authors did not receive funds, grants, or other support from any organization for the submitted work. Gene H. Barnett has received speaker and consultant honoraria from Monteris Medical. Martin C. Tom has received consultant honoraria from Viewray Inc and institutional research funding from Blue Earth Diagnostics Ltd. John H. Suh received consultant honoraria from Novocure, Philips, and Neutron Therapeutics. Samuel T. Chao received consultant honoraria to Varain Medical Systems, Manmeet S. Ahluwalia was given grants from Astrazeneca, BMS, Bayer, Incyte, Pharmacyclics, Novocure, Mimivax, Merck as well as consultant honoraria from Bayer, Novocure, Kiyatec, Insightec, GSK, Xoft, Nuvation, Cellularity, SDP Oncology, Apollomics, Prelude, Janssen, Forma therapeutics, Astrazeneca, Karyopharm, BMS, Tocagen, Abbvie, VBI Vaccines, Flatiron, Bayer, Varian Medical Systems, Voyager therapeutics. Manmeet S. Ahluwalia owns stocks in Doctible, Mimivax, Cytodyn, MedInnovate Advisors LLC. The other authors have no financial or proprietary interests in any material discussed in this article. The authors have no relevant non-financial interests to disclose.

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Authors and Affiliations

  1. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland Clinic, Cleveland, OH, USA

    Deborah Y. Park, Surabhi Tewari, Jennifer S. Yu, Samuel T. Chao, John H. Suh, David M. Peereboom, Glen H. J. Stevens, Gene H. Barnett, Richard Naugle & Erin S. Murphy

  2. Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL, USA

    Martin C. Tom & Manmeet S. Ahluwalia

  3. Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue/CA-60, Cleveland, OH, 44195, USA

    Yanwen Chen & Brittany Lapin

  4. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, 9500 Euclid Avenue/CA-50, Cleveland, OH, 44195, USA

    Jennifer S. Yu, Samuel T. Chao, John H. Suh & Erin S. Murphy

  5. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center and Neurological Institute, Cleveland Clinic, Cleveland, USA

    Samuel T. Chao, John H. Suh, David M. Peereboom, Glen H. J. Stevens, Gene H. Barnett, Lilyana Angelov, Alireza Mohammadi & Erin S. Murphy

  6. Department of Neuropsychology, Cleveland Clinic, Cleveland, OH, USA

    Thomas Hogan, Courtney Kissel & Richard Naugle

  7. Department of Psychiatry, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA

    Isabel Schuermeyer

  8. Neuro-Oncology Center and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Michael W. Parsons

  9. Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Gene H. Barnett

Authors
  1. Deborah Y. Park
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  2. Martin C. Tom
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  3. Yanwen Chen
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  4. Surabhi Tewari
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  5. Manmeet S. Ahluwalia
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  6. Jennifer S. Yu
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  7. Samuel T. Chao
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  8. John H. Suh
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  9. David M. Peereboom
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  10. Glen H. J. Stevens
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  11. Gene H. Barnett
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  12. Lilyana Angelov
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  13. Alireza Mohammadi
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  14. Thomas Hogan
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  15. Courtney Kissel
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  16. Brittany Lapin
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  17. Isabel Schuermeyer
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  18. Michael W. Parsons
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  19. Richard Naugle
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  20. Erin S. Murphy
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Yanwen Chen, Deborah Park, and Dr. Erin Murphy. The first draft of the manuscript was written by Deborah Park and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Erin S. Murphy.

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The authors have no competing interests to declare that are relevant to the content of this article.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Park, D.Y., Tom, M.C., Chen, Y. et al. Cognitive function after concurrent temozolomide-based chemoradiation therapy in low-grade gliomas. J Neurooncol 158, 341–348 (2022). https://doi.org/10.1007/s11060-022-04019-2

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  • DOI: https://doi.org/10.1007/s11060-022-04019-2

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