Cognition and quality of life after chemotherapy plus radiotherapy (RT) vs. RT for pure and mixed anaplastic oligodendrogliomas: radiation therapy oncology group trial 9402.
OBJECTIVE
Radiation Therapy Oncology Group 9402 compared procarbazine, lomustine, and vincristine (PCV) chemotherapy plus radiation therapy (PCV + RT) vs. RT alone for anaplastic oligodendroglioma. Here we report longitudinal changes in cognition and quality of life, effects of patient factors and treatments on cognition, quality of life and survival, and prognostic implications of cognition and quality of life.


METHODS
Cognition was assessed by Mini Mental Status Examination (MMSE) and quality of life by Brain-Quality of Life (B-QOL). Scores were analyzed for survivors and within 5 years of death. Shared parameter models evaluated MMSE/B-QOL with survival.


RESULTS
For survivors, MMSE and B-QOL scores were similar longitudinally and between treatments. For those who died, MMSE scores remained stable initially, whereas B-QOL slowly declined; both declined rapidly in the last year of life and similarly between arms. In the aggregate, scores decreased over time (p = 0.0413 for MMSE; p = 0.0016 for B-QOL) and were superior with age <50 years (p < 0.001 for MMSE; p = 0.0554 for B-QOL) and Karnofsky Performance Score (KPS) 80-100 (p < 0.001). Younger age and higher KPS were associated with longer survival. After adjusting for patient factors and drop-out, survival was longer after PCV + RT (HR = 0.66, 95% CI = 0.49-0.9, p = 0.0084; HR = 0.74, 95% CI = 0.54-1.01, p = 0.0592) in models with MMSE and B-QOL. In addition, there were no differences in MMSE and B-QOL scores between arms (p = 0.4752 and p = 0.2767, respectively); higher scores predicted longer survival.


CONCLUSIONS
MMSE and B-QOL scores held steady in the upper range in both arms for survivors. Younger, fitter patients had better MMSE and B-QOL and longer survival.
Wang
Meihua
M
American College of Radiology, Philadelphia, PA 19103, USA. mwang@phila.acr.org
Cairncross
Gregory
G
Shaw
Edward
E
Jenkins
Robert
R
Scheithauer
Bernd
B
Brachman
David
D
Buckner
Jan
J
Fink
Karen
K
Souhami
Luis
L
Laperriere
Normand
N
Mehta
Minesh
M
Curran
Walter
W
D000367:Age Factors; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D003071:Cognition / Q000187:drug effects / Q000528:radiation effects; D003131:Combined Modality Therapy / Q000379:methods / Q000401:mortality; D006801:Humans; D017567:Karnofsky Performance Status; D008130:Lomustine / Q000008:administration & dosage; D008137:Longitudinal Studies; D008609:Mental Status Schedule; D008875:Middle Aged; D009837:Oligodendroglioma / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy*; D011344:Procarbazine / Q000008:administration & dosage; D011788:Quality of Life; D016019:Survival Analysis; D014750:Vincristine / Q000008:administration & dosage
D011344:Procarbazine; D014750:Vincristine; D008130:Lomustine