title: Radiotherapy in low-grade glioma adult patients: a retrospective survival and neurocognitive toxicity analysis.
abstract: OBJECTIVE
  The treatment of low-grade glioma is still debated. Surgery is the first-line approach, and the correct timing of radiation therapy has not yet been defined since "early" radiation therapy improves relapse-free survival but not overall survival. Since a longer progression-free survival is desirable, the main issue related to radiotherapy is the incidence of late neurocognitive toxicity.
  
  
  METHODS
  Ninety-five patients with low-grade glioma were consecutively treated with early (within 3 months) or late (at disease progression) post-surgical radiation therapy. Clinical and therapeutic factors were entered into the analysis overall (OS) and progression-free (PFS) survival, and the distribution in two accrual periods identified based on the evolution of imaging procedures and radiotherapy techniques were compared. For 6/18 long survivors (LS) without evidence of disease, neurocognitive evaluation was obtained and the dose to the hippocampus region was retrospectively calculated.
  
  
  RESULTS
  Univariate analysis of OS showed a statistically significant advantage for grade 1 and oligodendroglioma histology, better performance status [Karnofsky index (KI)], age <40 years, radical surgery, no steroid treatment; PFS was significantly related with younger age, better KI and "early" radiotherapy. Multivariate analysis of OS confirmed the significance of all variables except surgery; for PFS, only "early" radiotherapy and better KI retained significance. Memory impairment was evident in 4/6 of the LS tested; quality of life was good and executive functions were normal.
  
  
  CONCLUSIONS
  Radiotherapy remains an essential component in the treatment of low-grade glioma. Prospective studies are needed to evaluate the relative contributions of the disease itself and of surgery, radiation and chemotherapy to long-term neurocognitive damage.
authors.affiliation: Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy, buglione@med.unibs.it.
authors.forename: Michela
authors.initials: M
authors.lastname: Buglione
authors.forename: Sara
authors.initials: S
authors.lastname: Pedretti
authors.forename: Stefano
authors.initials: S
authors.lastname: Gipponi
authors.forename: Alice
authors.initials: A
authors.lastname: Todeschini
authors.forename: Ludovica
authors.initials: L
authors.lastname: Pegurri
authors.forename: Loredana
authors.initials: L
authors.lastname: Costa
authors.forename: Laura
authors.initials: L
authors.lastname: Donadoni
authors.forename: Salvatore
authors.initials: S
authors.lastname: Grisanti
authors.forename: Marco
authors.initials: M
authors.lastname: Fontanella
authors.forename: Roberto
authors.initials: R
authors.lastname: Liserre
authors.forename: Fabio
authors.initials: F
authors.lastname: Facchetti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
authors.forename: Stefano Maria
authors.initials: SM
authors.lastname: Magrini
mesh_terms: D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D003072:Cognition Disorders / Q000175:diagnosis*; D005260:Female; D005910:Glioma / Q000532:radiotherapy* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome