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Effects of Radiotherapy on Cognitive
Function in Patients With Low-Grade Glioma Measured by the Folstein
Mini-Mental State Examination
Paul D. Brown,
Jan C. Buckner, Judith R. O’Fallon, Nancy
L. Iturria, Cerise A. Brown, Brian P.
O’Neill, Bernd W. Scheithauer, Robert P.
Dinapoli, Robert M. Arusell, Walter J.
Curran, Ross Abrams, Edward G. Shaw
From the Mayo Clinic, Rochester, MN;
Roger Maris Cancer Center, Fargo, ND; Radiation Therapy Oncology Group
(RTOG) Operations Office, Philadelphia, PA; and Wake Forest
University, School of Medicine, Winston-Salem, NC. Address reprint
requests to Paul D. Brown, MD, Division of Radiation Oncology, Mayo
Clinic, 200 First St SW, Rochester, MN 55905. Submitted April 24,
2002; accepted April 8, 2003.
Purpose.
To assess the neurocognitive effects of cranial radiotherapy on
patients with low-grade gliomas, we analyzed cognitive performance
data collected in a prospective, intergroup clinical trial.
Methods. Patients
included 203 adults with supratentorial low-grade gliomas
randomly assigned to a lower dose (50.4 Gy in 28 fractions) or
a higher dose (64.8 Gy in 36 fractions) of localized radiotherapy.
Folstein Mini-Mental State Examination (MMSE) scores and neurologic
function scores (NFS) at baseline and key evaluations were
analyzed.
Median follow-up was 7.4 years in 101 patients still alive.
A change of more than three MMSE points was considered clinically
significant.
Results. In patients
without tumor progression, significant deterioration from
baseline occurred at years 1, 2, and 5 in 8.2%, 4.6%, and
5.3% of patients, respectively.
Most patients with an abnormal baseline MMSE score (<
27) experienced significant increases.
Baseline variables such as radiation dose, conformal versus
conventional radiotherapy, number of radiation fields, age,
sex, tumor size, NFS, seizures, and seizure medications did
not predict cognitive function changes.
Conclusion. In this
population, most low-grade glioma patients maintained a
stable neurocognitive status after focal radiotherapy as
measured by the MMSE.
Patients with an abnormal baseline MMSE were more likely to
have an improvement in cognitive abilities than
deterioration after receiving radiotherapy.
Only a small percentage of patients had cognitive
deterioration after radiotherapy.
However, more discriminating neurocognitive assessment tools may
identify cognitive decline not apparent with the use of the
MMSE.
© 2003 American Society for
Clinical Oncology
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