Long-term neurocognitive function and quality of life after multimodal therapy in adult glioma patients: a prospective long-term follow-up
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Long-term neurocognitive function and quality of life after multimodal therapy in adult glioma patients: a prospective long-term follow-up. / Pertz, Milena; Schlömer, Sabine; Seidel, Clemens; Hentschel, Bettina; Löffler, Markus; Schackert, Gabriele; Krex, Dietmar; Juratli, Tareq; Tonn, Joerg Christian; Schnell, Oliver; Vatter, Hartmut; Simon, Matthias; Westphal, Manfred; Martens, Tobias; Sabel, Michael; Bendszus, Martin; Dörner, Nils; Wick, Antje; Fliessbach, Klaus; Hoppe, Christian; Klingner, Marcel; Felsberg, Jörg; Reifenberger, Guido; Gramatzki, Dorothee; Weller, Michael; Schlegel, Uwe; German Glioma Network.
In: J NEURO-ONCOL, Vol. 164, No. 2, 09.2023, p. 353-366.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Long-term neurocognitive function and quality of life after multimodal therapy in adult glioma patients: a prospective long-term follow-up
AU - Pertz, Milena
AU - Schlömer, Sabine
AU - Seidel, Clemens
AU - Hentschel, Bettina
AU - Löffler, Markus
AU - Schackert, Gabriele
AU - Krex, Dietmar
AU - Juratli, Tareq
AU - Tonn, Joerg Christian
AU - Schnell, Oliver
AU - Vatter, Hartmut
AU - Simon, Matthias
AU - Westphal, Manfred
AU - Martens, Tobias
AU - Sabel, Michael
AU - Bendszus, Martin
AU - Dörner, Nils
AU - Wick, Antje
AU - Fliessbach, Klaus
AU - Hoppe, Christian
AU - Klingner, Marcel
AU - Felsberg, Jörg
AU - Reifenberger, Guido
AU - Gramatzki, Dorothee
AU - Weller, Michael
AU - Schlegel, Uwe
AU - German Glioma Network
N1 - © 2023. The Author(s).
PY - 2023/9
Y1 - 2023/9
N2 - PURPOSE: Multimodal therapies have significantly improved prognosis in glioma. However, in particular radiotherapy may induce long-term neurotoxicity compromising patients' neurocognition and quality of life. The present prospective multicenter study aimed to evaluate associations of multimodal treatment with neurocognition with a particular focus on hippocampal irradiation.METHODS: Seventy-one glioma patients (WHO grade 1-4) were serially evaluated with neurocognitive testing and quality of life questionnaires. Prior to (baseline) and following further treatment (median 7.1 years [range 4.6-11.0] after baseline) a standardized computerized neurocognitive test battery (NeuroCog FX) was applied to gauge psychomotor speed and inhibition, verbal short-term memory, working memory, verbal and non-verbal memory as well as verbal fluency. Mean ipsilateral hippocampal radiation dose was determined in a subgroup of 27 patients who received radiotherapy according to radiotherapy plans to evaluate its association with neurocognition.RESULTS: Between baseline and follow-up mean performance in none of the cognitive domains significantly declined in any treatment modality (radiotherapy, chemotherapy, combined radio-chemotherapy, watchful-waiting), except for selective attention in patients receiving chemotherapy alone. Apart from one subtest (inhibition), mean ipsilateral hippocampal radiation dose > 50 Gy (Dmean) as compared to < 10 Gy showed no associations with long-term cognitive functioning. However, patients with Dmean < 10 Gy showed stable or improved performance in all cognitive domains, while patients with > 50 Gy numerically deteriorated in 4/8 domains.CONCLUSIONS: Multimodal glioma therapy seems to affect neurocognition less than generally assumed. Even patients with unilateral hippocampal irradiation with > 50 Gy showed no profound cognitive decline in this series.
AB - PURPOSE: Multimodal therapies have significantly improved prognosis in glioma. However, in particular radiotherapy may induce long-term neurotoxicity compromising patients' neurocognition and quality of life. The present prospective multicenter study aimed to evaluate associations of multimodal treatment with neurocognition with a particular focus on hippocampal irradiation.METHODS: Seventy-one glioma patients (WHO grade 1-4) were serially evaluated with neurocognitive testing and quality of life questionnaires. Prior to (baseline) and following further treatment (median 7.1 years [range 4.6-11.0] after baseline) a standardized computerized neurocognitive test battery (NeuroCog FX) was applied to gauge psychomotor speed and inhibition, verbal short-term memory, working memory, verbal and non-verbal memory as well as verbal fluency. Mean ipsilateral hippocampal radiation dose was determined in a subgroup of 27 patients who received radiotherapy according to radiotherapy plans to evaluate its association with neurocognition.RESULTS: Between baseline and follow-up mean performance in none of the cognitive domains significantly declined in any treatment modality (radiotherapy, chemotherapy, combined radio-chemotherapy, watchful-waiting), except for selective attention in patients receiving chemotherapy alone. Apart from one subtest (inhibition), mean ipsilateral hippocampal radiation dose > 50 Gy (Dmean) as compared to < 10 Gy showed no associations with long-term cognitive functioning. However, patients with Dmean < 10 Gy showed stable or improved performance in all cognitive domains, while patients with > 50 Gy numerically deteriorated in 4/8 domains.CONCLUSIONS: Multimodal glioma therapy seems to affect neurocognition less than generally assumed. Even patients with unilateral hippocampal irradiation with > 50 Gy showed no profound cognitive decline in this series.
KW - Humans
KW - Adult
KW - Follow-Up Studies
KW - Brain Neoplasms/complications
KW - Quality of Life
KW - Prospective Studies
KW - Glioma/complications
KW - Combined Modality Therapy
U2 - 10.1007/s11060-023-04419-y
DO - 10.1007/s11060-023-04419-y
M3 - SCORING: Journal article
C2 - 37648934
VL - 164
SP - 353
EP - 366
JO - J NEURO-ONCOL
JF - J NEURO-ONCOL
SN - 0167-594X
IS - 2
ER -
