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Effect
of radiotherapy and other treatment-related factors on mid-term to
long-term cognitive sequelae in low-grade gliomas: a comparative study
Klein
M, Heimans JJ, Aaronson NK, van der Ploeg HM, Grit J, Muller M, Postma
TJ, Mooij JJ, Boerman RH, Beute GN, Ossenkoppele GJ, van Imhoff GW,
Dekker AW, Jolles J, Slotman BJ, Struikmans H, Taphoorn MJ
Department of Medical Psychology, Vrije Universiteit Medical
Centre, Amsterdam, The Netherlands. m.klein.psychol@med.vu.nl
Background. Because survival benefits of treatment with
radiotherapy are questionable and such treatment can cause substantial
damage to the brain over time, the optimum management strategy for
low-grade gliomas remains controversial.
We
aimed to identify the specific effects of radiotherapy on objective
and self-reported cognitive function, and on cognitive deterioration
over time, in patients with low-grade gliomas treated with early
radiotherapy.
Methods.
195 patients with low-grade glioma (of whom 104 had received
radiotherapy 1-22 years previously) were compared with 100 low-grade
haematological patients and 195 healthy controls.
Our
analyses aimed to differentiate between the effects of the tumour (eg,
disease duration, lateralisation) and treatment effects (neurosurgery,
radiotherapy, antiepileptic drugs) on cognitive function and on
relative risk of cognitive disability.
Findings.
Low-grade glioma patients had lower ability in all cognitive domains
than did low-grade haematological patients, and did even less well by
comparison with healthy controls.
Use
of radiotherapy was associated with poorer cognitive function;
however, cognitive disability in the memory domain was found only in
radiotherapy patients who received fraction doses exceeding 2
Gy.
Antiepileptic
drug use was strongly associated with disability in attentional and
executive function.
Interpretation.
Our findings suggest that the tumour itself has the most deleterious
effect on cognitive function and that radiotherapy mainly results in
additional long-term cognitive disability when high fraction doses are
used.
Additionally,
the effects of other medical factors, especially antiepileptic drug
use, on cognitive function in glioma patients deserve attention.
PMID: 12423981 [PubMed - indexed for MEDLINE]
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