NQPC-2 Cognitive function of a low-grade glioma patient treated with radiation therapy 28 years ago

Abstract While there are many reports that long-term survivors of low-grade glioma patients treated with radiation therapy cannot lead a healthy social life due to cognitive dysfunction, we report a low-grade glioma patient with almost normal cognitive function even after radiation therapy 28 years ago. CASE REPORT. A 64-year-old woman developed with sudden left hemiparesis and was diagnosed as a small infarction in the left corona radiata. After treated by anticoagulant therapy, she was admitted to our hospital for rehabilitation. Twenty-eight years ago, she underwent surgical resection and radiation therapy with 60 Gy for astrocytoma (WHO grade 2) in the right insular cortex. At the time of this admission, she presented with a good MMSE score of 30 points, but she couldn’t walk and her left hand was less maneuverable. After 109 days of intensive rehabilitation in our hospital, she was discharged on a cane walk, and returned to work as a gas station clerk. COGNITIVE FUNCION. We evaluated her cognitive function on TMT-A/B test, CAT (Clinical Assessment for Attention)and WAIS-4. The TMT test was normal with age adjustments. In CAT, the percentage of correct answers for the 7 constituent items was within the standard range, but in the task of evaluating the required time, a slight delay in processing speed was observed. In WAIS-4, the Full scale IQ was 98 points (normal range) including normal 3 of 4 constituent items. But, only the PSI (processing speed) of 75 point was below the standard range. CONCLUSION: We observed a slight delay in processing speed on her high-level cognitive function tests, but determined that she would be well-adapted to a familiar job in a small community. In fact, she was doing well on the job 10 months after her discharge.

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Effect of the Addition of Chemotherapy to Radiotherapy on Cognitive Function in Patients With Low-Grade Glioma: Secondary Analysis of RTOG 98-02

Journal of Clinical Oncology ◽

10.1200/jco.2013.53.1830 ◽

2014 ◽

Vol 32 (6) ◽

pp. 535-541 ◽

Cited By ~ 64

Author(s):

Roshan S. Prabhu ◽

Minhee Won ◽

Edward G. Shaw ◽

Chen Hu ◽

David G. Brachman ◽

...

Keyword(s):

Cognitive Function ◽

Mmse Score ◽

Randomized Study ◽

Progression Free Survival ◽

Low Grade Glioma ◽

Subtotal Resection ◽

Low Grade ◽

Who Grade ◽

Term Survival ◽

Over Time

Purpose The addition of PCV (procarbazine, lomustine, and vincristine) chemotherapy to radiotherapy (RT) for patients with WHO grade 2 glioma improves progression-free survival (PFS). The effect of therapy intensification on cognitive function (CF) remains a concern in this population with substantial long-term survival. Patients and Methods A total of 251 patients with WHO grade 2 glioma age ≥ 40 years with any extent of resection or age < 40 years with subtotal resection/biopsy were randomly assigned to RT (54 Gy) or RT plus PCV. We observed 111 patients age < 40 years with gross total resection. CF was assessed by Mini–Mental State Examination (MMSE) at baseline and years 1, 2, 3, and 5. Results Overall, few patients experienced significant decline in MMSE score. There were no significant differences in the proportion of patients experiencing MMSE score decline between the randomized study arms at any time point. Both study arms experienced a significant gain in average MMSE score longitudinally over time, with no difference between arms. Conclusion The MMSE is a relatively insensitive tool, and subtle changes in CF may have been missed. However, the addition of PCV to RT did not result in significantly higher rates of MMSE score decline than RT alone through 5 years of follow-up. Patients in both randomly assigned arms experienced a statistically significant average MMSE score increase over time, with no difference between arms. The addition of PCV chemotherapy to RT improves PFS without excessive CF detriment over RT alone for patients with low-grade glioma.

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Randomized Trial of Radiation Therapy Plus Procarbazine, Lomustine, and Vincristine Chemotherapy for Supratentorial Adult Low-Grade Glioma: Initial Results of RTOG 9802

Journal of Clinical Oncology ◽

10.1200/jco.2011.35.8598 ◽

2012 ◽

Vol 30 (25) ◽

pp. 3065-3070 ◽

Cited By ~ 194

Author(s):

Edward G. Shaw ◽

Meihua Wang ◽

Stephen W. Coons ◽

David G. Brachman ◽

Jan C. Buckner ◽

...

Keyword(s):

Radiation Therapy ◽

Radiation Therapy Oncology Group ◽

Progression Free Survival ◽

Low Grade Glioma ◽

Subtotal Resection ◽

Low Grade ◽

Eligibility Criteria ◽

Who Grade ◽

Free Survival ◽

Post Hoc

PurposeA prior Radiation Therapy Oncology Group (RTOG) clinical trial in anaplastic oligodendroglioma suggested a progression-free survival benefit for procarbazine, lomustine, and vincristine (PCV) chemotherapy in addition to radiation therapy (RT), as have smaller trials in low-grade glioma (LGG).Patients and MethodsEligibility criteria included supratentorial WHO grade 2 LGG, age 18 to 39 years with subtotal resection/biopsy, or age ≥ 40 years with any extent resection. Patients were randomly assigned to RT alone or RT followed by six cycles of PCV. Survival was compared by using the modified Wilcoxon and log-rank tests.ResultsIn all, 251 patients were accrued from 1998 to 2002. Median overall survival (OS) time and 5-year OS rates for RT versus RT + PCV were 7.5 years versus not reached and 63% versus 72%, respectively (hazard ratio [HR]; 0.72; 95% CI, 0.47 to 1.10; P = .33; log-rank P = .13). Median progression-free survival (PFS) time and 5-year PFS rates for RT versus RT + PCV were 4.4 years versus not reached and 46% versus 63%, respectively (HR, 0.6; 95% CI, 0.41 to 0.86; P = .06; log-rank P = .005). OS and PFS were similar for all patients between years 0 and 2. After 2 years, OS and PFS curves separated significantly, favoring RT + PCV. For 2-year survivors (n = 211), the probability of OS for an additional 5 years was 74% with RT + PCV versus 59% with RT alone (HR, 0.52; 95% CI, 0.30 to 0.90; log-rank P = .02).ConclusionPFS but not OS was improved for adult patients with LGG receiving RT + PCV versus RT alone. On post hoc analysis, for 2-year survivors, the addition of PCV to RT conferred a survival advantage, suggesting a delayed benefit for chemotherapy.

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The effect of the addition of chemotherapy to radiotherapy on cognitive function in patients with low-grade glioma: Secondary analysis of RTOG 98-02.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.2047 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. 2047-2047

Author(s):

Roshan Sudhir Prabhu ◽

Minhee Won ◽

Edward G. Shaw ◽

Meihua Wang ◽

David Brachman ◽

...

Keyword(s):

Cognitive Function ◽

Mmse Score ◽

Low Grade Glioma ◽

Subtotal Resection ◽

Low Grade ◽

Who Grade ◽

Term Survival ◽

Who Grade Ii Glioma ◽

Grade Ii ◽

Grade Ii Glioma

2047 Background: The addition of PCV chemotherapy to radiotherapy (RT) for patients with WHO grade II glioma improves progression free survival (PFS) and overall survival (OS), for patients surviving at least 2 years (Shaw, J Clin Oncol 26: 2008). The effect of therapy intensification on cognitive function (CF) remains a concern in this population with substantial long term survival. Methods: 251patients with WHO grade II glioma and age > 40 with any extent of resection, or age < 40 with subtotal resection/biopsy were randomized to RT (54Gy) or RT + PCV. 111 patients with age < 40 and gross total resection were observed. CF was assessed by mini-mental status exam (MMSE)at baseline and years 1, 3, and 5 for patients without progression. Change in MMSE score from baseline of > 3 points was considered clinically significant. Results: Overall, very few patients experienced significant decline in MMSE score, with a median follow-up time of 9.7 years for alive patients. There were no significant differences in the proportion of patients experiencing MMSE decline between study arms at any time point. The table below summarizes MMSE change from baseline over time. Neither baseline MMSE score nor change in MMSE at year 1 significantly predicted for OS or PFS, but there was a trend towards worse OS for patients with MMSE loss of ≥ 2 points [HR 1.73, 95% CI (0.86, 3.47), p=0.12]. Conclusions: The MMSE is a relatively insensitive tool that has not been validated in patients receiving cranial RT, and subtle changes in CF may have been missed. However, the addition of PCV to RT for low grade glioma did not result in significantly higher rates of MMSE decline than RT alone or observation. There was a trend towards an MMSE decline of ≥ 2 points at year 1 predicting for worse OS. [Table: see text]

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NCOG-20. LONGITUDINAL ASSESSMENT OF SUBJECTIVE COGNITIVE FUNCTION IN ADULTS WITH LOW GRADE GLIOMA TREATED WITH PROTON RADIATION THERAPY

Neuro-Oncology ◽

10.1093/neuonc/noab196.611 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi156-vi156

Author(s):

Giuliana Zarrella ◽

Michael Parsons ◽

Janet Sherman ◽

Jorg Dietrich ◽

Helen Shih

Keyword(s):

Radiation Therapy ◽

Cognitive Function ◽

Cognitive Decline ◽

Low Grade Glioma ◽

Low Grade ◽

Proton Radiation ◽

Change Scores ◽

Proton Radiation Therapy ◽

Subjective Cognitive Function

Abstract INTRODUCTION Our group previously demonstrated stability in neurocognitive function (NCF) over a 5-year period after proton radiation therapy (PRT) in low grade glioma (LGG) patients. Subjective cognitive function (SCF) had not been previously explored, nor had individual analyses of cognition, which can detect variability in trajectory. We used the newly derived Functional Assessment of Cancer Therapy-Brain Cognitive-Index (FACT-Br-CI) to examine SCF in LGG patients after PRT and compare longitudinal changes in SCF and NCF. METHODS 20 LGG patients (M age =37.5) treated with PRT completed NCF tests and self-report measures annually for 5 years or until tumor progression. Group change in SCF was examined with paired t-test (baseline vs final FACT-Br-CI). Individual change scores were calculated for FACT-Br-CI and NCF tests (clinical trials battery composite; CTBC). Individual deterioration in NCF was defined by reliable change index (RCI) on CTBC, and in SCF was defined as decline of >/=1 SD in FACT-Br-CI. Relationships between change in SCF and NCF were explored with correlations. RESULTS At the group level, no change was observed in FACT-Br-CI between baseline and last follow-up (t(19)=-.91;p=ns). Individual SCF analyses at last follow-up found the number of patients reporting decline=3 (15%), improvement=5 (25%), and no change=12 (60%). Individual changes were observed in SCF in 20% of patients at 3 months, 5.9% at 6 months, 12.5% at 12 months, 13.3% at 24 months, and 11.1% at 36 months. Median time to any deterioration in SCF was 36 months and for NCF was not reached. Correlation between CTBC and FACT-Br-CI change scores did not reach statistical significance (r=.41;p=ns). CONCLUSION Consistent with previous research, group analyses of LGG patients did not show cognitive decline after PRT. However individual analyses of SCF showed variability within the group: some patients experienced cognitive decline during follow up. Consideration of individual differences may yield additional information.

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Glioma with Leptomeningeal Spread Mimics Chronic Meningoencephalitis in a Young Adult

Case Reports in Neurology ◽

10.1159/000513562 ◽

2021 ◽

pp. 179-183

Author(s):

Ann-Kristin Becker ◽

Marta Leonora Frank ◽

Michael Friese ◽

Joachim Röther

Keyword(s):

Brain Tumor ◽

Back Pain ◽

Young Adult ◽

Lower Back Pain ◽

Low Grade Glioma ◽

Low Grade ◽

Who Grade ◽

Leptomeningeal Spread ◽

Lower Back ◽

Uncommon Case

The most malignant type of intrinsic brain tumor is glioblastoma (WHO grade IV). Primary leptomeningeal spread is rare and leads to a variety of differential considerations, as there is no typical clinical or imaging pattern. Here we present a rare and uncommon case of a primary leptomeningeal glioblastoma in combination with a low-grade glioma in a 21-year-old male, initially presenting with only headache and lower back pain. The presented case illustrates the challenging differential considerations and the severe course of leptomeningeal glioblastomas.

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Predictors of subjective versus objective cognitive functioning in patients with stable grades II and III glioma

Neuro-Oncology Practice ◽

10.1093/nop/npu035 ◽

2015 ◽

Vol 2 (1) ◽

pp. 20-31 ◽

Cited By ~ 13

Author(s):

Karin Gehring ◽

Martin J.B. Taphoorn ◽

Margriet M. Sitskoorn ◽

Neil K. Aaronson

Keyword(s):

Mental Health ◽

Cognitive Function ◽

Cognitive Functioning ◽

Well Being ◽

Low Grade Glioma ◽

Motor Dysfunction ◽

Low Grade ◽

Physical And Mental Health ◽

Subjective Cognitive Function ◽

Mental Health Factors

Abstract Background Studies in cancer and noncancer populations demonstrate lower than expected correlations between subjective cognitive symptoms and cognitive functioning as determined by standardized neuropsychological tests. This paper systematically examines the association between subjective and objective cognitive functioning in patients with low-grade glioma and the associations of these indicators of cognitive function with clusters of sociodemographic, clinical, and self-reported physical and mental health factors. Methods Multiple regression analyses with the subjective and 2 objective indicators of cognitive functioning as dependent variables and 4 clusters of predictor variables were conducted in 169 patients with predominantly low-grade glioma. Results Correlations between the subjective and the 2 objective cognitive indicators were negligible (0.04) to low (0.24). Objective cognitive deficits were predominantly associated with sociodemographic (older age, lower education, male sex) and clinical (left hemisphere tumor) variables, while lower ratings of subjective cognitive function were more closely related to self-reported mental health symptoms (fatigue, lower mental well-being), physical (motor) dysfunction and female sex. Self-reported communication deficits were associated significantly with both subjective and objective dysfunction. Conclusions We recommend that both subjective and objective measures of cognitive functioning, together with a measure of psychological distress, be used for comprehensive neuropsychological assessments of patients with glioma to determine which areas are most affected and which specific intervention strategies are most appropriate.

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