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LETTER TO THE EDITOR
Year : 2013  |  Volume : 9  |  Issue : 4  |  Page : 757-758

Neurocognitive functioning in patients of high-grade gliomas


Department of Clinical Oncology and Radiation Therapy, Charles University Hospital and Faculty of Medicine, Hradec Kralove, Czech Republic

Date of Web Publication11-Feb-2014

Correspondence Address:
Slovacek Ladislav
Department of Clinical Oncology and Radiation Therapy, Charles University Hospital and Faculty of Medicine, Hradec Kralove
Czech Republic
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.126493

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How to cite this article:
Ladislav S. Neurocognitive functioning in patients of high-grade gliomas. J Can Res Ther 2013;9:757-8

How to cite this URL:
Ladislav S. Neurocognitive functioning in patients of high-grade gliomas. J Can Res Ther [serial online] 2013 [cited 2019 Dec 16];9:757-8. Available from: http://www.cancerjournal.net/text.asp?2013/9/4/757/126493

Sir,

I read with great interest the article by authors Anand, et al., devoted to the issue of neurotoxicity in patients of high-grade gliomas treated with conformal radiation and temozolomide. [1] I would like this original work added to their own experience with neurocognitive functioning assessment in patients of glioblastoma multiforme (GBM). It is know that GBM belongs to the most aggressive brain tumors with limited therapeutic options. In the clinical presentation often dominate the mental changes (memory loss, impaired speech, changes in personality, and temperament). Our pilot study was local, prospective. and longitudinal. From the January 1, 2009 to the June 30, 2010, the evaluation of neurocognitive functioning had been performed in 11 patients with GBM (9 women, 2 men) with a mean age of 56.8 years (age range 45-72). Four patients underwent total resection of GBM, subtotal resection was performed in five patients and two patients had stereobiopsy. The localization of GBM was in six patients in the frontal lobe, in two patients in frontotemporal area, in two patients in frontoparietal area and in one patient in parieto-occipital area. All patients underwent postoperative external-beam radiotherapy with a 25 mm margin at a dose of 50 Gy in 25 fractions and a boost to the tumor with a 15 mm margin at a dose of 10 Gy in five fractions with chemotherapy of temozolomide at dose 75 mg/m 2 . The assessment of neurocognitive functions was performed by clinical neuropsychologist using the methods sensitive for cognitive deficit. We used one complex screening method (ACE-R), two graphomotoric tests (TMT, ROCF), two verbal tests (DS, VFT), and one computer-administered test (CPT). The total examination time took about 1 hour. The schedule of examination during the pilot study was following: (1) before radiotherapy with chemotherapy (performed in all 11 patients), (2) immediately after radiotherapy with chemotherapy (performed in 7 patients), (3) 1 month from finishing the adjuvant treatment (performed in 5 patients), (4) 3 months after finishing the adjuvant treatment (performed in 1 patient, (5) 6 months after finishing the treatment (performed in 1 patient). Due to the rapid progression of glioblastoma multiforme and related alterations of somatic and mental status, only one patient underwent the whole planned schedule of examinations. In our pilot project, we detect a big variability in cognitive functions in the first assessment (before radiotherapy). The reason of this variability is with high probability associated with different way and invasiveness of selected neurosurgery intervention. Patients, who underwent the most radical neurosurgery, had the worst results. The average score in ACE-R test in a group of four patients with complete resection was 75.5 points, in group of five patients with partial or subtotal resection 84.1 points and in group of two patients with stereobiopsy 87.8 points. For any similar monitoring of patients in the future, it would be appropriate to implement the first neuropsychological assessment before the surgery. This would then allow to distinguish the negative impact of radiotherapy with/without chemotherapy from the traumatic impact of neurosurgical intervention. The different impact or combination of above mentioned factors is, together with tumor progression and localization of GBM, a reason of different progress of cognitive functions during the follow up period. To monitor developments and changes in cognitive functions in patients with GBM, the following battery of neuropsychological tests has shown helpful information: Addenbrooke's Cognitive Examination, Trail Making Test, Rey-Osterrieth Complex Figure, and Verbal Fluency Test. It seems that this battery of neuropsychological tests is suitable for repeated long-term monitoring of cognitive function in cancer patients undergoing radiotherapy of brain.

 
 > References Top

1.Anand AK, Chaudhory AR, Aggarwal HN, Sachdeva PK, Negi PS, Sinha SN, et al. Survival outcome and neurotoxicky in patients of high-grade gliomas treated with conformal radiation and temozolomide. J Cancer Res Ther 2012;8:50-6  Back to cited text no. 1
    




 

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