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Cognitive functions in low-grade
gliomas: disease and treatment effects Denise D. Correa1,
2,*, Lisa M. DeAngelis1, 2, Weiji Shi3,
Howard T. Thaler3, Michael Lin2
and Lauren E. Abrey1, 2
(1)Department
of Neurology, Memorial Sloan-Kettering Cancer Center, 1275 York
Avenue, New York, NY 10021, USA. (2)Department of Neurology and
Neuroscience, Weill Medical College of Cornell University, 1275 York
Avenue, New York, NY 10021, USA. (3)Departments of Epidemiology
and Biostatistics, Memorial Sloan-Kettering Cancer Center, 525 East
68th Street, New York, NY 10021, USA.
*Correspondence: Denise D. Correa, Email: corread@mskcc.org,
Phone: +212-639-2082, Fax: +646-422-2235
Received: 11 April 2006 Accepted: 8 June 2006 Published
online: 19 July 2006
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Background. The
role of radiotherapy and chemotherapy in the treatment of low-grade
gliomas (LGG) is controversial regarding their effect on survival and
the development of neurotoxicity.
The few published studies examining adverse treatment effects on
cognition revealed conflicting results.
Objective.
To assess cognitive functioning in LGG patients who
received conformal radiation therapy (RT), chemotherapy, or no
treatment.
Design.
40 LGG patients participated in the study; 16 patients
had RT ± chemotherapy, and 24 patients had no
treatment.
All patients underwent a neuropsychological evaluation.
APOE genotype was obtained in 36 patients who were classified in two
groups based on the presence or absence of at least one apolipoprotein
E є-4 (APOE є-4) allele.
Results.
Treated LGG patients had lower scores than untreated
patients on several cognitive domains; patients who completed
treatment at intervals greater than 3 years and had long disease
duration had significantly lower scores on the Non-Verbal Memory
domain.
Antiepileptic polytherapy, treatment history, and disease duration
jointly contributed to low Psychomotor domain scores.
62% of treated patients showed white matter confluence on MRI, whereas
only 9% of the untreated patients had such changes.
Preliminary comparisons between APOE є-4 carriers (n = 9)
and non-carriers (n = 27) on cognitive domain scores
revealed no statistically significant differences, but APOE є-4
carriers had lower mean scores on the Verbal Memory domain than did
non-є-4 carriers.
Conclusions.
RT ± chemotherapy, disease duration, and
antiepileptic treatment contributed to mild cognitive difficulties in
LGG patients.
Keywords: Low-grade
glioma - Radiation - Chemotherapy - Neuropsychology - Cognitive
Presented in part at the American
Academy of Neurology Annual Meeting in April 2004, and at the World
Federation of Neuro-Oncology (WFNO) II/ European Association for Neuro-Oncology
VI Meeting in May 2005.
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