Klein Martin, Drijver A Josephine, van den Bent Martin J, Bromberg Jacolien C, Hoang-Xuan Khê, Taphoorn Martin J B, Reijneveld Jaap C, Ben Hassel Mohamed, Vauleon Elodie, Eekers Daniëlle B P, Tzuk-Shina Tzahala, Lucas Anna, Freixa Salvador Villà, Golfinopoulos Vasilis, Gorlia Thierry, Hottinger Andreas F, Stupp Roger, Baumert Brigitta G
Brain Tumor Center Amsterdam at Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
Brain Tumor Center at Erasmus Medical Center Cancer Institute, Rotterdam, the Netherlands.
Neuro Oncol. 2021 May 5;23(5):803-811. doi: 10.1093/neuonc/noaa252.
EORTC study 22033-26033 showed no difference in progression-free survival between high-risk low-grade glioma receiving either radiotherapy (RT) or temozolomide (TMZ) chemotherapy alone as primary treatment. Considering the potential long-term deleterious impact of RT on memory functioning, this study aims to determine whether TMZ is associated with less impaired memory functioning.
Using the Visual Verbal Learning Test (VVLT), memory functioning was evaluated at baseline and subsequently every 6 months. Minimal compliance for statistical analyses was set at 60%. Conventional indices of memory performance (VVLT Immediate Recall, Total Recall, Learning Capacity, and Delayed Recall) were used as outcome measures. Using a mixed linear model, memory functioning was compared between treatment arms and over time.
Neuropsychological assessment was performed in 98 patients (53 RT, 46 TMZ). At 12 months, compliance had dropped to 66%, restricting analyses to baseline, 6 months, and 12 months. At baseline, patients in either treatment arm did not differ in memory functioning, sex, age, or educational level. Over time, patients in both arms showed improvement in Immediate Recall (P = 0.017) and total number of words recalled (Total Recall; P < 0.001, albeit with delayed improvement in RT patients (group by time; P = 0.011). Memory functioning was not associated with RT gross, clinical, or planned target volumes.
In patients with high-risk low-grade glioma there is no indication that in the first year after treatment, RT has a deleterious effect on memory function compared with TMZ chemotherapy.
欧洲癌症研究与治疗组织（EORTC）22033 - 26033研究表明，高危低级别胶质瘤患者接受单纯放疗（RT）或替莫唑胺（TMZ）化疗作为初始治疗，其无进展生存期并无差异。鉴于放疗对记忆功能可能存在的长期有害影响，本研究旨在确定TMZ是否与记忆功能受损程度较轻相关。
使用视觉言语学习测试（VVLT），在基线时及随后每6个月评估记忆功能。统计分析的最低依从率设定为60%。记忆表现的常规指标（VVLT即刻回忆、总回忆、学习能力和延迟回忆）用作结局指标。使用混合线性模型，比较各治疗组之间以及随时间变化的记忆功能。
对98例患者（53例接受放疗，46例接受TMZ治疗）进行了神经心理学评估。在12个月时，依从率降至66%，分析限于基线、6个月和12个月的数据。在基线时，两个治疗组的患者在记忆功能、性别、年龄或教育水平方面并无差异。随着时间推移，两组患者的即刻回忆（P = 0.017）和回忆单词总数（总回忆；P < 0.001）均有改善，不过放疗患者的改善出现延迟（组间×时间；P = 0.011）。记忆功能与放疗的大体肿瘤体积、临床靶体积或计划靶体积无关。
对于高危低级别胶质瘤患者，没有迹象表明在治疗后的第一年，与TMZ化疗相比，放疗对记忆功能有有害影响。
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