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Journal of Neuro-Oncology

, Volume 108, Issue 2, pp 291–308 | Cite as

Changes in neurocognitive functioning and quality of life in adult patients with brain tumors treated with radiotherapy

  • Silvia ScocciantiEmail author
  • Beatrice Detti
  • Samantha Cipressi
  • Alberto Iannalfi
  • Ciro Franzese
  • Giampaolo Biti
Effects of Standard of Art Treatment

Abstract

This review aims to summarize what is currently known about neurocognitive outcome and quality of life in patients with brain tumors treated with radiotherapy. Whether potential tumor-controlling benefits of radiotherapy outweigh its potential toxicity in the natural history of brain tumors is a matter of debate. This review focuses on some of the adult main brain tumors, for which the issue of neurocognitive decline has been thoroughly studied: low-grade gliomas, brain metastases, and primary central nervous system lymphomas. The aims of this review are: (1) the analysis of existing data regarding the relationship between radiotherapy and neurocognitive outcome; (2) the identification of strategies to minimize radiotherapy-related neurotoxicity by reducing the dose or the volume; (3) the evidence-based data concerning radiotherapy withdrawal; and (4) the definition of patients subgroups that could benefit from immediate radiotherapy. For high grade gliomas, the main findings from literature are summarized and some strategies to reduce the neurotoxicity of the treatment are presented. Although further prospective studies with adequate neuropsychological follow-up are needed, this article suggests that cognitive deficits in patients with brain tumor have a multifactorial genesis: radiotherapy may contribute to the neurocognitive deterioration, but the causes of this decline include the tumor itself, disease progression, other treatment modalities and comorbidities. Treatment variables, such as total and fractional dose, target volume, and irradiation technique can dramatically affect the safety of radiotherapy: optimizing radiation parameters could be an excellent approach to improve outcome and to reduce neurotoxicity. At the same time, delayed radiotherapy could be a valid option for highly selected patients.

Keywords

Brain metastases Cognitive deficits High grade and low grade gliomas Neurotoxicity Primary central nervous system lymphomas 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC. 2012

Authors and Affiliations

  • Silvia Scoccianti
    • 1
    Email author
  • Beatrice Detti
    • 1
  • Samantha Cipressi
    • 1
  • Alberto Iannalfi
    • 1
  • Ciro Franzese
    • 1
  • Giampaolo Biti
    • 1
  1. 1.Radiation Oncology UnitAzienda Ospedaliera, Universitaria CareggiFlorenceItaly

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