Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, Universitätsstraße 105, 44789, Bochum, Germany.
Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr University Bochum, Bochum, Germany.
J Neurooncol. 2023 Sep;164(2):353-366. doi: 10.1007/s11060-023-04419-y. Epub 2023 Aug 30.
Multimodal therapies have significantly improved prognosis in glioma. However, in particular radiotherapy may induce long-term neurotoxicity compromising patients' neurocognition and quality of life. The present prospective multicenter study aimed to evaluate associations of multimodal treatment with neurocognition with a particular focus on hippocampal irradiation.
Seventy-one glioma patients (WHO grade 1-4) were serially evaluated with neurocognitive testing and quality of life questionnaires. Prior to (baseline) and following further treatment (median 7.1 years [range 4.6-11.0] after baseline) a standardized computerized neurocognitive test battery (NeuroCog FX) was applied to gauge psychomotor speed and inhibition, verbal short-term memory, working memory, verbal and non-verbal memory as well as verbal fluency. Mean ipsilateral hippocampal radiation dose was determined in a subgroup of 27 patients who received radiotherapy according to radiotherapy plans to evaluate its association with neurocognition.
Between baseline and follow-up mean performance in none of the cognitive domains significantly declined in any treatment modality (radiotherapy, chemotherapy, combined radio-chemotherapy, watchful-waiting), except for selective attention in patients receiving chemotherapy alone. Apart from one subtest (inhibition), mean ipsilateral hippocampal radiation dose > 50 Gy (Dmean) as compared to < 10 Gy showed no associations with long-term cognitive functioning. However, patients with Dmean < 10 Gy showed stable or improved performance in all cognitive domains, while patients with > 50 Gy numerically deteriorated in 4/8 domains.
Multimodal glioma therapy seems to affect neurocognition less than generally assumed. Even patients with unilateral hippocampal irradiation with > 50 Gy showed no profound cognitive decline in this series.
多种模式疗法显著改善了脑胶质瘤的预后。然而，放射治疗尤其可能导致长期的神经毒性，从而影响患者的神经认知和生活质量。本前瞻性多中心研究旨在评估多模式治疗与神经认知的相关性，特别关注海马照射。
71 名脑胶质瘤患者（世界卫生组织分级 1-4 级）接受了神经认知测试和生活质量问卷的连续评估。在基线时（治疗前）和进一步治疗后（中位时间为基线后 7.1 年[范围为 4.6-11.0]），应用标准化计算机神经认知测试组合（NeuroCog FX）评估精神运动速度和抑制、言语短期记忆、工作记忆、言语和非言语记忆以及言语流畅性。在接受放射治疗的 27 名患者亚组中确定了同侧海马的平均放射剂量，以评估其与神经认知的相关性。
在任何治疗模式下（放疗、化疗、放化疗联合、观察等待），除单独接受化疗的患者的选择性注意力外，在任何认知领域，从基线到随访的平均表现都没有显著下降。除一个子测试（抑制）外，与 Dmean<10Gy 的患者相比，Dmean>50Gy（Dmean）与长期认知功能无关联。然而，Dmean<10Gy 的患者在所有认知领域的表现稳定或改善，而 Dmean>50Gy 的患者在 4/8 个领域的表现呈数值下降。
多种模式的脑胶质瘤治疗似乎对神经认知的影响比普遍认为的要小。即使在接受单侧海马照射的患者中，Dmean>50Gy 的患者在本系列中也没有明显的认知下降。
