Mid-term treatment-related cognitive sequelae in glioma patients

Abstract

Purpose Cognitive functioning represents an essential determinant of quality of life. Since significant advances in neuro-oncological treatment have led to prolonged survival it is important to reliably identify possible treatment-related neurocognitive dysfunction in brain tumor patients. Therefore, the present study specifically evaluates the effects of standard treatment modalities on neurocognitive functions in glioma patients within two years after surgery. Methods Eighty-six patients with World Health Organization (WHO) grade 1–4 gliomas were treated between 2004 and 2012 and prospectively followed within the German Glioma Network. They received serial neuropsychological assessment of attention, memory and executive functions using the computer-based test battery NeuroCog FX. As the primary outcome the extent of change in cognitive performance over time was compared between patients who received radiotherapy, chemotherapy or combined radio-chemotherapy and patients without any adjuvant therapy. Additionally, the effect of irradiation and chemotherapy was assessed in subgroup analyses. Furthermore, the potential impact of the extent of tumor resection and histopathological characteristics on cognitive functioning were referred to as secondary outcomes. Results After a median of 16.8 (range 5.9–31.1) months between post-surgery baseline neuropsychological assessment and follow-up assessment, all treatment groups showed numerical and often even statistically significant improvement in all cognitive domains. The extent of change in cognitive functioning showed no difference between treatment groups. Concerning figural memory only, irradiated patients showed less improvement than non-irradiated patients (p = 0.029, η2 = 0.06). Resected patients, yet not patients with biopsy, showed improvement in all cognitive domains. Compared to patients with astrocytomas, patients with oligodendrogliomas revealed a greater potential to improve in attentional and executive functions. However, the heterogeneity of the patient group and the potentially selected cohort may confound results. Conclusion Within a two-year post-surgery interval, radiotherapy, chemotherapy or their combination as standard treatment did not have a detrimental effect on cognitive functions in WHO grade 1–4 glioma patients. Cognitive performance in patients with adjuvant treatment was comparable to that of patients without.

has-miR-134-5p inhibits the proliferation and migration of glioma cells by regulating the BDNF/ERK signaling pathway

“…Although surgical resection, radiotherapy, chemotherapy, and other comprehensive treatment modalities were implemented, the majority of patients exhibited an unfavorable prognosis. Consequently, the exploration of novel biomarkers for early detection has emerged as a pivotal endeavor to enhance the diagnosis and management of glioma [10][11][12].…”

Improved prognostic stratification of patients with isocitrate dehydrogenase-mutant astrocytoma

“…The MGMT promoter methylation status was determined by methylation-specific PCR or DNA pyrosequencing [ 14 , 46 ] or, in individual cases, by DNA methylome analysis using the STP27 algorithm [ 1 ]. A total of 173 of the 212 GGN cases had been included in previous GGN studies [ 5 , 6 , 19 , 20 , 22 , 27 , 36 , 37 , 39 , 40 , 48 – 51 , 53 ].…”

Long-term neurocognitive function and quality of life after multimodal therapy in adult glioma patients: a prospective long-term follow-up

“…Most glioma studies with long-term follow-ups were not prospective [ 22 , 23 , 27 ] and prospective studies on hippocampal RT dose [ 20 ] did not exceed follow-up testing beyond 18 months. Since our group had not found relevant changes of cognitive performance after multimodal treatment of patients with WHO grade 1–4 gliomas after a median of 16.8 months between post-surgery baseline neuropsychological assessment and follow-up assessment [ 28 ], we now present an extended follow-up to assess whether neurocognitive sequelae may occur in the long-term. Neuropsychological and QoL data was prospectively captured in a large multicenter trial (German Glioma Network, GGN) with a follow-up of up to 11 years and with particular focus on the influence of hippocampal RT dosage on long-term neurotoxicity.…”