Phase II study of alpha‐tocopherol in improving the cognitive function of patients with temporal lobe radionecrosis

Abstract

BACKGROUND Radiotherapy is an important treatment modality for brain tumors and is the standard radical treatment for nasopharyngeal carcinoma (NPC). However, the treatment is not free of side effects, and one possible neurologic sequela is the occurrence of temporal lobe radionecrosis (TLN) associated with cognitive dysfunction. Currently, there is no effective intervention to improve patients' cognitive performance. METHODS Twenty‐nine patients with TLN after radiotherapy for NPC were recruited on a voluntary basis. Among them, 19 patients (15 males and 4 females) received a megadose of alpha‐tocopherol (vitamin E) (2000 international units per day) for 1 year, whereas the other 10 (5 males and 5 females) served as control patients. Their cognitive function (i.e., global cognitive ability, attention, memory, language, and executive function) was evaluated by a battery of neuropsychological tests before and after treatment. RESULTS Significant improvement in global cognitive ability (P = 0.035) and memory (verbal: P = 0.036; visual: P = 0.007) occurred among patients in the treatment group after a 1‐year medication period. In addition, the executive function of the treatment group improved significantly (P = 0.04). No difference was found between the two groups with respect to attention or language. CONCLUSIONS The current investigation was a preliminary study on the effect of alpha‐tocopherol on the cognitive function of patients with TLN after radiotherapy for NPC. In view of the absence of effective treatment for patients with cerebral radionecrosis, alpha‐tocopherol has the potential to be a complementary intervention for patients with cognitive dysfunction due to TLN. Cancer 2004;100:398–404. © 2003 American Cancer Society.

Clinical Patterns and Biological Correlates of Cognitive Dysfunction Associated with Cancer Therapy

“…Stimulant therapies have proven effective in treating cognitive dysfunction in cancer patients [102]. Preliminary data suggest that high doses of ␣-tocopherol may improve cognitive function (i.e., memory and executive function) in patients with temporal lobe necrosis after radiation for nasopharyngeal carcinoma [103]. Trials of anti-inflammatory therapies during and/or after radiotherapy are in the early stages of planning and execution.…”

Brain Ischemia and Hypometabolism Treated by Ozone Therapy

“…Limited approaches are available for RBI when symptoms are progressive and lesions are not suitable for surgery. Proposed therapies with the objective of improving blood perfusion/oxygenation include anticoagulants [17], hyperbaric chambers [18,19], spinal cord stimulation [20], and modification of the radiation-induced pro-oxidative status using vitamin E [21].…”

Evidence-Based Interventions for Cancer- and Treatment-Related Cognitive Impairment

“…Two small studies evaluated the impact of natural restorative environmental intervention on cognitive function in patients with breast cancer (Cimprich, 1993;Cimprich & Ronis, 2003). One study used a pre-and • Natural restorative environmental (Cimprich, 1993;Cimprich & Ronis, 2003) • Qigong (Oh et al, 2012) • Structured rehabilitation (Rottmann et al, 2012) • Vitamin E (Chan et al, 2004;Jatoi et al, 2005) • Pharmacologic approaches -Methylphenidate (Bruera et al, 1992;Butler et al, 2007;Escalante et al, 2014;Gagnon et al, 2005;Gehring et al, 2012;Gong et al, 2014;Lower et al, 2009;Mar Fan et al, 2008;Meyers et al, 1998;Schwartz et al, 2002 Both studies noted improvements in the capacity to direct attention for patients prior to adjuvant therapy. Further research is needed to explore its effect on cognitive function after cancer treatment.…”