Cognitive functions in low-grade gliomas: disease and treatment effects
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The role of radiotherapy and chemotherapy in the treatment of low-grade gliomas (LGG) is controversial regarding their effect on survival and the development of neurotoxicity. The few published studies examining adverse treatment effects on cognition revealed conflicting results.
To assess cognitive functioning in LGG patients who received conformal radiation therapy (RT), chemotherapy, or no treatment.
40 LGG patients participated in the study; 16 patients had RT ± chemotherapy, and 24 patients had no treatment. All patients underwent a neuropsychological evaluation. APOE genotype was obtained in 36 patients who were classified in two groups based on the presence or absence of at least one apolipoprotein E є-4 (APOE є-4) allele.
Treated LGG patients had lower scores than untreated patients on several cognitive domains; patients who completed treatment at intervals greater than 3 years and had long disease duration had significantly lower scores on the Non-Verbal Memory domain. Antiepileptic polytherapy, treatment history, and disease duration jointly contributed to low Psychomotor domain scores. 62% of treated patients showed white matter confluence on MRI, whereas only 9% of the untreated patients had such changes. Preliminary comparisons between APOE є-4 carriers (n = 9) and non-carriers (n = 27) on cognitive domain scores revealed no statistically significant differences, but APOE є-4 carriers had lower mean scores on the Verbal Memory domain than did non-є-4 carriers.
RT ± chemotherapy, disease duration, and antiepileptic treatment contributed to mild cognitive difficulties in LGG patients.
KeywordsLow-grade glioma Radiation Chemotherapy Neuropsychology Cognitive
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The authors thank Aviva Glass, Angeles Cheung, and Jocelyn Dantis for their assistance with data acquisition and management.
- 2.Davis FG, Freels S, Grutsch J, Barlas S, Brem S (1998) Survival rates in patients with primary malignant brain tumors stratified by age and tumor histological type: an analysis based on surveillance, epidemiology, and end results (SEER) data, 1973–1991. J Neurosurg 88:1–10PubMedCrossRefGoogle Scholar
- 6.Buckner JC, Gesme D Jr, O’Fallon JR et al (2003) Phase II trial of procarbazine, lomustine, and vincristine as initial therapy for patients with low-grade oligodendroglioma or oligoastrocytoma: efficacy and associations with chromosomal abnormalities. J Clin Oncol 21:251–255PubMedCrossRefGoogle Scholar
- 8.Shaw EG (1995) The low-grade glioma debate: evidence defending the position of early radiotherapy. Clin Neur 42:448–494Google Scholar
- 11.Karim AB, Afra D, Cornu P et al (2002) Randomized trial on the efficacy of radiotherapy for cerebral low-grade glioma in the adult: European Organization for Research and Treatment of Cancer study 22845 with the Medical Research Council study BR04: an interim analysis. Int J Radiat Oncol 52:316–324CrossRefGoogle Scholar
- 13.Karim AB, Cornu P, Bleehen N et al (1998) Immediate postoperative radiotherapy in low-grade glioma improves progression free survival, but not overall survival: preliminary results of an EORTC/MRC randomized phase III study. Proc Am Soc Clin Oncol 17:400AGoogle Scholar
- 29.Lezak MD (1995) Neuropsychological assessment, 3rd edn. Oxford University Press, New YorkGoogle Scholar
- 33.Fazekas F, Chawluk JB, Alavi A, Hurtig HI, Zimmerman RA (1987) MR signal abnormalities at 1.5 T in Alzheimer’s␣dementia and normal aging. Am J Neuroradiol 8:421–426Google Scholar
- 40.Goldberg E, Podell K, Lovell M (1994) Lateralization of frontal lobe functions and novelty. J Neuropsych Clin Ni 6:371–378Google Scholar
- 46.Bondi MW, Salmon DP, Monsch AU et al (1995) Episodic memory changes are associated with the APOE-epsilon 4 allele in nondemented older adults. Neurology 46:2203–2206Google Scholar
- 54.Behin A, Delattre JY (2003) Neurologic sequelae of radiotherapy of the nervous system. In: Schiff D, Wen PY (eds) Cancer neurology in clinical practice. Humana Press, Totowa, pp 173–192Google Scholar