title: Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study.
abstract: BACKGROUND
  Because survival benefits of treatment with radiotherapy are questionable and such treatment can cause substantial damage to the brain over time, the optimum management strategy for low-grade gliomas remains controversial. We aimed to identify the specific effects of radiotherapy on objective and self-reported cognitive function, and on cognitive deterioration over time, in patients with low-grade gliomas treated with early radiotherapy.
  
  
  METHODS
  195 patients with low-grade glioma (of whom 104 had received radiotherapy 1-22 years previously) were compared with 100 low-grade haematological patients and 195 healthy controls. Our analyses aimed to differentiate between the effects of the tumour (eg, disease duration, lateralisation) and treatment effects (neurosurgery, radiotherapy, antiepileptic drugs) on cognitive function and on relative risk of cognitive disability.
  
  
  RESULTS
  Low-grade glioma patients had lower ability in all cognitive domains than did low-grade haematological patients, and did even less well by comparison with healthy controls. Use of radiotherapy was associated with poorer cognitive function; however, cognitive disability in the memory domain was found only in radiotherapy patients who received fraction doses exceeding 2 Gy. Antiepileptic drug use was strongly associated with disability in attentional and executive function.
  
  
  CONCLUSIONS
  Our findings suggest that the tumour itself has the most deleterious effect on cognitive function and that radiotherapy mainly results in additional long-term cognitive disability when high fraction doses are used. Additionally, the effects of other medical factors, especially antiepileptic drug use, on cognitive function in glioma patients deserve attention.
authors.affiliation: Department of Medical Psychology, Vrije Universiteit Medical Centre, Amsterdam, The Netherlands. m.klein.psychol@med.vu.nl
authors.forename: M
authors.initials: M
authors.lastname: Klein
authors.forename: J J
authors.initials: JJ
authors.lastname: Heimans
authors.forename: N K
authors.initials: NK
authors.lastname: Aaronson
authors.forename: H M
authors.initials: HM
authors.lastname: van der Ploeg
authors.forename: J
authors.initials: J
authors.lastname: Grit
authors.forename: M
authors.initials: M
authors.lastname: Muller
authors.forename: T J
authors.initials: TJ
authors.lastname: Postma
authors.forename: J J
authors.initials: JJ
authors.lastname: Mooij
authors.forename: R H
authors.initials: RH
authors.lastname: Boerman
authors.forename: G N
authors.initials: GN
authors.lastname: Beute
authors.forename: G J
authors.initials: GJ
authors.lastname: Ossenkoppele
authors.forename: G W
authors.initials: GW
authors.lastname: van Imhoff
authors.forename: A W
authors.initials: AW
authors.lastname: Dekker
authors.forename: J
authors.initials: J
authors.lastname: Jolles
authors.forename: B J
authors.initials: BJ
authors.lastname: Slotman
authors.forename: H
authors.initials: H
authors.lastname: Struikmans
authors.forename: M J B
authors.initials: MJ
authors.lastname: Taphoorn
mesh_terms: D000328:Adult; D001921:Brain / Q000528:radiation effects*; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000209:etiology*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005910:Glioma / Q000145:classification / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009483:Neuropsychological Tests; D011597:Psychomotor Performance / Q000528:radiation effects*; D011832:Radiation Injuries / Q000503:physiopathology*; D013997:Time Factors