Health-related quality of life and cognitive failures in patients with lower-grade gliomas treated with radiotherapy

Perri, Dario Di; Jmil, S.; Lawson, Tévi Morel; Calster, Laurens Van; Whenham, Nicolas; Renard, Laurette

doi:10.1016/j.canrad.2022.10.004

Cited by 6 publications

(7 citation statements)

References 23 publications

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“…However, these comparative results should not be understood to imply a low humanistic burden in low-grade glioma in absolute terms – impaired physical, cognitive, and emotional functioning are observed in 35%, 50%, and 48% of patients, respectively, within 5 years of treatment ( 72 ). Physical, cognitive, and emotional functioning and QoL in patients with low-grade glioma remains below age-matched general population levels ( 73 ).…”

Section: Burdenmentioning

confidence: 99%

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

Pöhlmann,

Weller,

Marcellusi

et al. 2024

Front. Oncol.

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Gliomas are a group of heterogeneous tumors that account for substantial morbidity, mortality, and costs to patients and healthcare systems globally. Survival varies considerably by grade, histology, biomarkers, and genetic alterations such as IDH mutations and MGMT promoter methylation, and treatment, but is poor for some grades and histologies, with many patients with glioblastoma surviving less than a year from diagnosis. The present review provides an introduction to glioma, including its classification, epidemiology, economic and humanistic burden, as well as treatment options. Another focus is on treatment recommendations for IDH-mutant astrocytoma, IDH-mutant oligodendroglioma, and glioblastoma, which were synthesized from recent guidelines. While recommendations are nuanced and reflect the complexity of the disease, maximum safe resection is typically the first step in treatment, followed by radiotherapy and/or chemotherapy using temozolomide or procarbazine, lomustine, and vincristine. Immunotherapies and targeted therapies currently have only a limited role due to disappointing clinical trial results, including in recurrent glioblastoma, for which the nitrosourea lomustine remains the de facto standard of care. The lack of treatment options is compounded by frequently suboptimal clinical practice, in which patients do not receive adequate therapy after resection, including delayed, shortened, or discontinued radiotherapy and chemotherapy courses due to treatment side effects. These unmet needs will require significant efforts to address, including a continued search for novel treatment options, increased awareness of clinical guidelines, improved toxicity management for chemotherapy, and the generation of additional and more robust clinical and health economic evidence.

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Section: Burdenmentioning

confidence: 99%

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

Pöhlmann,

Weller,

Marcellusi

et al. 2024

Front. Oncol.

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“…However, this concept widely surpasses the intrasurgical decision making, since it may encourage sequential and delayed reoperation to optimize the extent of resection without inducing a cognitive deficit, given the fact that plasticity follows an evolving pattern [17]. It can also be applied to radiotherapy strategies, given the negative impact of WM irradiations on neurocognitive functioning [54], or even to chemotherapy, since some patients may not be eligible for sufficient surgical cytoreduction (typically when more than 10 ± 5 mL of tumor infiltrates functional WM tracts). In this setting, patients may benefit from a first line "neoadjuvant" chemotherapy before being reconsidered for a radical surgical (re)treatment [55].…”

Section: Toward An Individual Onco-functional Balancementioning

confidence: 99%

“…However, the deleterious effect of radiation on cognition (particularly in terms of attentional and executive processes) has been reported in patients with long-term follow-up (>12 years), even at doses traditionally considered safe (<2 Gy) [110]. A recent report also advocates for earlier detrimental consequences of radiation, with up to 50% of patients suffering from cognitive and emotional disturbances after a median follow-up of 5 years [54]. The effects of modern radiation technologies (including intensity modulated radiotherapy, volumetric modulated arc therapy, or proton therapy) on long-term cognitive functioning remain unknown, with reports only reaching a limited follow-up [111,112] and usually based on restrained neuropsychological batteries (e.g., mini-mental state examination) [112,113].…”

Section: Radiotherapymentioning

confidence: 99%

Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies

Duffau

2023

Cancers

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The ability of neural circuits to compensate for damage to the central nervous system is called postlesional plasticity. In diffuse low-grade gliomas (LGGs), a crosstalk between the brain and the tumor activates modulations of plasticity, as well as tumor proliferation and migration, by means of paracrine and electrical intercommunications. Such adaptative mechanisms have a major impact on the benefits and risks of oncological treatments but are still disregarded by current neuro-oncological guidelines. In this review, the authors first aimed to highlight clinical, radiological, and oncological markers that robustly reflect the plasticity potentials and limitations in LGG patients, including the location of the tumor and the degree of critical white matter tract infiltration, the velocity of tumor expansion, and the reactional changes of neuropsychological performances over time. Second, the interactions between the potential/limitations of cerebral plasticity and the efficacy/tolerance of treatment options (i.e., surgery, chemotherapy, and radiotherapy) are reviewed. Finally, a longitudinal and multimodal treatment approach accounting for the evolutive profiles of brain plasticity is proposed. Such an approach integrates personalized predictive models of plasticity potentials with a step-by-step therapeutic decision making and supports onco-functional balanced strategies in patients with LGG, with the ultimate aim of optimizing overall survival and quality of life.

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“…Radiation-induced injury is multifactorial and complex, mainly characterised by vascular abnormalities, inflammation, gliosis, demyelination, and-at high doses-white matter necrosis [1,2]. Standard radiation treatment for brain tumours includes high dosage megavoltage radiation to the cranial vault; however, a high proportion (50% to 90%) of these patients develop impaired cognition and dysfunction, which is highly disabling and progressive [1,3,4].…”

Section: Introductionmentioning

confidence: 99%

Neural and Onconeural Autoantibodies and Blood–Brain Barrier Disruption Markers in Patients Undergoing Radiotherapy for High-Grade Primary Brain Tumour

Hojan,

Adamska,

Lewandowska

et al. 2024

Diagnostics

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Radiotherapy (RT) plays a key role in brain tumours but can negatively impact functional outcomes and quality of life. The aim of this study was to analyse anti-neural and onconeural autoantibodies and markers of blood–brain barrier (BBB) disruption in patients with primary brain cancer undergoing RT. Materials and methods. A prospective study was conducted on 45 patients with a brain tumour scheduled for intensity-modulated radiotherapy. Assessments were performed at baseline, post-RT, and at three months. We measured serum levels of BBB disruption biomarkers and anti-neural, onconeural, and organ-specific antibodies. Results. Antibodies against nucleosome antigens and neuronal surface antigens were detected in 85% and 3% of cases, respectively; anti-neural and onconeural antibodies were observed in 47% and 5.8%. In 44% patients, ≥2 antibody types were detected. No significant changes in BBB biomarkers were observed. Conclusion. The findings of this study show that a humoral immune response is common in patients undergoing RT for brain cancer. This response appears to be non-organ specific but rather directed against nucleosome antigens, but onconeural antibodies were uncommon, suggesting a low risk of a neurological paraneoplastic syndrome. Our data suggested that radiotherapy may not affect BBB integrity, but larger studies are needed to better characterise the pathophysiological effects of RT.

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Health-related quality of life and cognitive failures in patients with lower-grade gliomas treated with radiotherapy

Cited by 6 publications

References 23 publications

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies

Neural and Onconeural Autoantibodies and Blood–Brain Barrier Disruption Markers in Patients Undergoing Radiotherapy for High-Grade Primary Brain Tumour

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