A randomized trial of stereotactic versus conventional radiotherapy in young patients with low-grade brain tumors: occupational therapy-based neurocognitive data

Abstract

Background Radiotherapy for brain tumors in young patients is not only associated with improved survival but also long-term neurocognitive sequelae. We aimed to compare group differences in the executive neurocognitive outcomes in young patients with low-grade brain tumors treated with Stereotactic Conformal Radiotherapy (SCRT) and Conventional RT(ConvRT) techniques. Methods This a phase-3 randomized trial that enrolled 200 young patients with benign brain tumors and low-grade gliomas. Patients were randomly allocated (1:1) to either SCRT or ConvRT arms and treated to a dose of 54 Gy in 30 fractions over 6 weeks. Lowenstein Occupational Therapy Cognitive Assessment battery was performed at pre-radiotherapy baseline, 6 months, and annually thereafter until 5 years. Executive functions measures included orientation, visual perception, spatial perception, motor praxis, visuomotor organization, thinking operations and attention &concentration. The trajectory of these parameters was compared between the treatment arms over 5 years. Results Two hundred patients were enrolled in the study (SCRT:104 & ConvRT:96).The median age was 13 years [IQR:9-17]; mean total neurocognitive scores over 5 years were significantly superior in SCRT arm as compared to ConvRT (difference in slope: 2.27;p = 0.024). Outcomes improved in the SCRT arm vis-à-vis ConvRT for the subdomain of visuomotor organization (difference in slope:0.66, P<0.001). Visuomotor organization scores significantly improved in majority of the sub-stratification groups. Spatial perception improved in craniopharyngioma patients with SCRT technique as opposed to ConvRT. Conclusions SCRT achieved superior outcomes compared to ConvRT in certain executive neurocognitive functional domains. We provide high level of evidence in favor of SCRT.

Baseline neurocognitive dysfunction is ubiquitous in intrinsic brain tumors– results from a large Indian cohort of patients and analysis of factors associated with domain-specific dysfunction

“…Most studies reporting NCF have done so in the postoperative setting prior to adjuvant therapy. 22 , 23 , 24 , 25 NCDs in such patients may be mistakenly attributed to the surgical intervention. In the preoperative setting, Borde et al assessed prevalence of frontal lobe disfunction in 50 patients using the frontal assessment battery (FAB) and reported 76% dysfunction.…”

Adiponectin and Nitric Oxide Deficiency-Induced Cognitive Impairment in Fatigued Home-Resident in Mature and Older Adults: A Case-Control Study

“…In our recently published study, lower physical activity, higher adiposity markers, and diabetic-related parameters (HbA1c %, insulin) were shown to be significantly correlated with fatigue scores in patients with type 2 diabetes mellitus (T2DM) [ 39 ]. The detrimental effects of lower physical activity and VO 2 max on the fatigue stage may be related to alterations in the production and utilization of adenosine triphosphate (ATP), limitations in oxygen supply, deficits of blood oxygenation, and oxygen-carrying capacity among subjects with advanced ages [ 61 – 64 ].…”

“…In recent and previous research studies, LOTCA as a diagnostic tool was successfully used to measure mental health problems among both healthy and older adults with medical complications [ 39 – 44 ]. A prevalidated cognitive assessment (LOTCA), consisting of 7 subsets of questions, was applied to measure cognitive ability among the participants within 30 minutes [ 39 – 44 ].…”

“…In recent and previous research studies, LOTCA as a diagnostic tool was successfully used to measure mental health problems among both healthy and older adults with medical complications [ 39 – 44 ]. A prevalidated cognitive assessment (LOTCA), consisting of 7 subsets of questions, was applied to measure cognitive ability among the participants within 30 minutes [ 39 – 44 ]. The test was used for assessing psychiatric domains among participants, where higher scores (123) indicated better cognitive ability and those with minimum scores (27) showed significant degrees of cognitive impairment, as mentioned elsewhere in the literature [ 39 – 44 ].…”

“…A prevalidated cognitive assessment (LOTCA), consisting of 7 subsets of questions, was applied to measure cognitive ability among the participants within 30 minutes [ 39 – 44 ]. The test was used for assessing psychiatric domains among participants, where higher scores (123) indicated better cognitive ability and those with minimum scores (27) showed significant degrees of cognitive impairment, as mentioned elsewhere in the literature [ 39 – 44 ]. The participants were classified as normal (LOTCA score: 93–123), moderate (LOTCA score 62–92), and severe cognitive ability (LOTCA score 31–61).…”