Sharma Prashasti, Medhi Partha Pratim, Kalita Apurba Kumar, Bhattacharyya Mouchumee, Nath Jyotiman, Sarma Gautam, Yanthan Yanpothung
Department of Radiation Oncology, Dr. B. Borooah Cancer Institute, Guwahati, Assam, India.
Department of Radiation Oncology, All India Institute of Medical Sciences, Guwahati, Assam, India.
Brain Tumor Res Treat. 2023 Jul;11(3):183-190. doi: 10.14791/btrt.2023.0004.
High-grade gliomas (HGG) are highly fatal tumors despite advanced multimodality management. They are also associated with neurocognitive impairment, both due to disease pathology and treatment. We aimed to assess various risk factors responsible for neurocognitive decline in HGG patients undergoing adjuvant chemoradiation.
Newly diagnosed HGG patients who underwent maximal safe resection were included. Patients received volumetric modulated arc therapy to a dose of 60 Gy in 30 fractions, along with concurrent temozolomide (TMZ) at a dose of 75 mg/m²/day orally; thereafter adjuvant TMZ (150-200 mg/m² for 5 days), given every 28 days for 6 to 8 cycles. The Mini-Mental State Examination questionnaire was used to measure cognitive impairment of each study patient at various time points. Cox regression model was used for univariate and multivariable analysis of data to establish possible risk factors.
Fifty-three patients were enrolled and analyzed. At a median follow-up of 15 months, 30 patients (56.6%) developed cognitive impairment, and 23 patients (43.4%) did not. On univariate analysis, HGG with WHO grade 4, glioblastoma and diffuse midline glioma histology, IDH-wild type, recursive partitioning analysis class IV/V, and only biopsy of primary tumor were significantly associated with neurocognitive impairment, but none of them were independent risk factors on multivariable analysis. Planning target volume and dose received by ipsilateral hippocampus were also significantly correlated with cognitive decline in HGG patients.
Decline in neurocognitive functions in HGG patients is multifactorial and can be attributed to an amalgam of various tumor, patient, and treatment-related factors.
尽管采用了先进的多模式治疗方法，高级别胶质瘤（HGG）仍是高度致命的肿瘤。由于疾病病理和治疗原因，它们还与神经认知障碍有关。我们旨在评估接受辅助放化疗的HGG患者神经认知功能下降的各种危险因素。
纳入新诊断的接受了最大安全切除的HGG患者。患者接受容积调强弧形放疗，剂量为60 Gy，分30次给予，同时口服替莫唑胺（TMZ），剂量为75 mg/m²/天；此后给予辅助TMZ（150 - 200 mg/m²，共5天），每28天给药一次，共6至8个周期。使用简易精神状态检查表在不同时间点测量每位研究患者的认知障碍。采用Cox回归模型对数据进行单变量和多变量分析，以确定可能的危险因素。
共纳入53例患者并进行分析。中位随访15个月时，30例患者（56.6%）出现认知障碍，23例患者（43.4%）未出现。单变量分析显示，世界卫生组织4级HGG、胶质母细胞瘤和弥漫性中线胶质瘤组织学类型、异柠檬酸脱氢酶（IDH）野生型、递归分区分析IV/V级，以及仅对原发性肿瘤进行活检，均与神经认知障碍显著相关，但在多变量分析中，它们均不是独立危险因素。同侧海马体的计划靶体积和接受的剂量也与HGG患者的认知下降显著相关。
HGG患者神经认知功能下降是多因素的，可归因于各种肿瘤、患者和治疗相关因素的综合作用。
