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Cognitive and radiological effects of radiotherapy in patients with low-grade glioma: Long-term follow-up
The Lancet Neurology, 08/13/09

Douw L et al. – Long-term survivors of low-grade glioma (LGG) who did not have radiotherapy had stable radiological and cognitive status. In contrast, pts with low-grade glioma who received radiotherapy had progressive decline in attentional functioning, even with fraction doses regarded as safe (≤2 Gy). These cognitive deficits are associated with radiologic abnormalities.

Methods

Study of radiologic and cognitive abnormalities in survivors of LGG at 12-yr mean after first diagnosis
Follow-up for pts with stable disease since first assessment
Cognitive assessment: letter-digit substitution test, concept shifting test, Stroop color-word test, visual verbal learning test, memory comparison test, categoric word fluency
Compound scores in 6 cognitive domains: attention, executive functioning, verbal memory, working memory, psychomotor functioning, and information processing speed
Calculation for differences in compound scores between radiotherapy vs radiotherapy-naive pts
MRI scans to rate white-matter hyperintensities and global cortical atrophy

Results

Neuropsychological follow-up at mean of 12 yrs (range 6-28 yrs) for 65 pts
Radiotherapy for 32 pts (49%); 3 pts had fraction doses >2 Gy
More deficits affecting attentional functioning at second follow-up, regardless of fraction dose, for radiotherapy vs radiotherapy-naive pts
Pts who had radiotherapy also did worse in measures of executive functioning and information processing speed between the 2 assessments
Attentional functioning deteriorated significantly between first and second assessments in radiotherapy pts
Cognitive disabilities deficits in ≥5 of 18 neuropsychological test parameters for 17 radiotherapy pts (53%) vs 4 radiotherapy-naive pts (27%)
White-matter hyperintensities and global cortical atrophy associated with worse cognitive functioning in several domains

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