Effects of radiotherapy on cognitive function in patients with low-grade glioma measured by the folstein mini-mental state examination.
OBJECTIVE
To assess the neurocognitive effects of cranial radiotherapy on patients with low-grade gliomas, we analyzed cognitive performance data collected in a prospective, intergroup clinical trial.


METHODS
Patients included 203 adults with supratentorial low-grade gliomas randomly assigned to a lower dose (50.4 Gy in 28 fractions) or a higher dose (64.8 Gy in 36 fractions) of localized radiotherapy. Folstein Mini-Mental State Examination (MMSE) scores and neurologic function scores (NFS) at baseline and key evaluations were analyzed. Median follow-up was 7.4 years in 101 patients still alive. A change of more than three MMSE points was considered clinically significant.


RESULTS
In patients without tumor progression, significant deterioration from baseline occurred at years 1, 2, and 5 in 8.2%, 4.6%, and 5.3% of patients, respectively. Most patients with an abnormal baseline MMSE score (< 27) experienced significant increases. Baseline variables such as radiation dose, conformal versus conventional radiotherapy, number of radiation fields, age, sex, tumor size, NFS, seizures, and seizure medications did not predict cognitive function changes.


CONCLUSIONS
In this population, most low-grade glioma patients maintained a stable neurocognitive status after focal radiotherapy as measured by the MMSE. Patients with an abnormal baseline MMSE were more likely to have an improvement in cognitive abilities than deterioration after receiving radiotherapy. Only a small percentage of patients had cognitive deterioration after radiotherapy. However, more discriminating neurocognitive assessment tools may identify cognitive decline not apparent with the use of the MMSE.
Brown
Paul D
PD
Mayo Clinic, Division of Radiation Oncology, Rochester, MN 55905, USA.
Buckner
Jan C
JC
O'Fallon
Judith R
JR
Iturria
Nancy L
NL
Brown
Cerise A
CA
O'Neill
Brian P
BP
Scheithauer
Bernd W
BW
Dinapoli
Robert P
RP
Arusell
Robert M
RM
Curran
Walter J
WJ
Abrams
Ross
R
Shaw
Edward G
EG
D000328:Adult; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D003072:Cognition Disorders / Q000209:etiology*; D005260:Female; D005910:Glioma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008609:Mental Status Schedule; D011446:Prospective Studies; D011832:Radiation Injuries / Q000523:psychology*; D012307:Risk Factors