Long-term cognitive dysfunction after radiation therapy for primary brain tumors

TY - JOUR

T1 - Long-term cognitive dysfunction after radiation therapy for primary brain tumors

AU - Haldbo-Classen, Lene

AU - Amidi, Ali

AU - Wu, Lisa M

AU - Lukacova, Slavka

AU - Oettingen, Gorm von

AU - Gottrup, Hanne

AU - Zachariae, Robert

AU - Høyer, Morten

PY - 2019

Y1 - 2019

N2 - Background: The extent of radiation therapy (RT)-induced changes in cognitive function is unknown. RT with protons instead of photons spares the healthy brain tissue more and is believed to reduce the risk of cognitive dysfunction. There is modest knowledge on which parts of the brain we need to spare, to prevent cognitive dysfunction. To uncover which cognitive domains is most affected, we compared cognitive functioning in brain tumor patients treated with neurosurgery and RT with brain tumor patients treated with neurosurgery alone. Methods: A cross-sectional study assessing cognitive function in 110 patients with a primary brain tumor grades I-III or medulloblastoma (grade IV) treated at Aarhus University Hospital (AUH), Denmark between 2006 and 2016. Two cohorts were established: a cohort of 81 brain tumor patients who had received neurosurgery followed by RT (RT+), and a cohort of 29 brain tumor patients who had only received neurosurgery (RT-). The patients underwent questionnaires and neuropsychological assessment with standardized tests. Results: Mean age was 53.5 years with an average time since diagnosis of 7.3 years. Compared with normative data, lower average scores were observed for the entire group on domains concerning of verbal learning and memory ( p  < .001), attention and working memory ( p  < .001), processing speed ( p  < .001), and executive functioning ( p  < .001). Compared to RT- patients, RT + patients scored lower on domains concerning processing speed ( p  = .04) and executive function ( p  = .05) and had higher impairment frequency on verbal fluency ( p  = .02) with 16% of patients exceeding 1.5 SD below normative data. Conclusions: Our results indicate that treatment, including RT, for a primary brain tumor may have negative long-term impact on cognitive function, especially on processing speed and executive function.

AB - Background: The extent of radiation therapy (RT)-induced changes in cognitive function is unknown. RT with protons instead of photons spares the healthy brain tissue more and is believed to reduce the risk of cognitive dysfunction. There is modest knowledge on which parts of the brain we need to spare, to prevent cognitive dysfunction. To uncover which cognitive domains is most affected, we compared cognitive functioning in brain tumor patients treated with neurosurgery and RT with brain tumor patients treated with neurosurgery alone. Methods: A cross-sectional study assessing cognitive function in 110 patients with a primary brain tumor grades I-III or medulloblastoma (grade IV) treated at Aarhus University Hospital (AUH), Denmark between 2006 and 2016. Two cohorts were established: a cohort of 81 brain tumor patients who had received neurosurgery followed by RT (RT+), and a cohort of 29 brain tumor patients who had only received neurosurgery (RT-). The patients underwent questionnaires and neuropsychological assessment with standardized tests. Results: Mean age was 53.5 years with an average time since diagnosis of 7.3 years. Compared with normative data, lower average scores were observed for the entire group on domains concerning of verbal learning and memory ( p  < .001), attention and working memory ( p  < .001), processing speed ( p  < .001), and executive functioning ( p  < .001). Compared to RT- patients, RT + patients scored lower on domains concerning processing speed ( p  = .04) and executive function ( p  = .05) and had higher impairment frequency on verbal fluency ( p  = .02) with 16% of patients exceeding 1.5 SD below normative data. Conclusions: Our results indicate that treatment, including RT, for a primary brain tumor may have negative long-term impact on cognitive function, especially on processing speed and executive function.

KW - CANCER

KW - DEFICITS

KW - IMPAIRMENT

KW - LOW-GRADE GLIOMAS

KW - QUALITY-OF-LIFE

KW - RADIOTHERAPY

UR - http://www.scopus.com/inward/record.url?scp=85061515831&partnerID=8YFLogxK

U2 - 10.1080/0284186X.2018.1557786

DO - 10.1080/0284186X.2018.1557786

M3 - Journal article

C2 - 30757955

SN - 0284-186X

VL - 58

SP - 745

EP - 752

JO - Acta Oncologica

JF - Acta Oncologica

IS - 5

ER -