Background: Our previous study on cognitive functioning among 195 patients with low-grade glioma (LGG) a mean of 6 years after diagnosis suggested that the tumour itself, rather than the radiotherapy used to treat it, has the most deleterious effect on cognitive functioning; only high fraction dose radiotherapy (>2 Gy) resulted in significant added cognitive deterioration. The present study assesses the radiological and cognitive abnormalities in survivors of LGG at a mean of 12 years after first diagnosis.
Methods: Patients who have had stable disease since the first assessment were invited for follow-up cognitive assessment (letter-digit substitution test, concept shifting test, Stroop colour-word test, visual verbal learning test, memory comparison test, and categoric word fluency). Compound scores in six cognitive domains (attention, executive functioning, verbal memory, working memory, psychomotor functioning, and information processing speed) were calculated to detect differences between patients who had radiotherapy and patients who did not have radiotherapy. White-matter hyperintensities and global cortical atrophy were rated on MRI scans.
Findings: 65 patients completed neuropsychological follow-up at a mean of 12 years (range 6-28 years). 32 (49%) patients had received radiotherapy (three had fraction doses >2 Gy). The patients who had radiotherapy had more deficits that affected attentional functioning at the second follow-up, regardless of fraction dose, than those who did not have radiotherapy (-1.6 [SD 2.4] vs -0.1 [1.3], p=0.003; mean difference 1.4, 95% CI 0.5-2.4). The patients who had radiotherapy also did worse in measures of executive functioning (-2.0 [3.7] vs -0.5 [1.2], p=0.03; mean difference 1.5, 0.2-2.9) and information processing speed (-2.0 [3.7] vs -0.6 [1.5], p=0.05; mean difference 0.8, 0.009-1.6]) between the two assessments. Furthermore, attentional functioning deteriorated significantly between the first and second assessments in patients who had radiotherapy (p=0.25). In total, 17 (53%) patients who had radiotherapy developed cognitive disabilities deficits in at least five of 18 neuropsychological test parameters compared with four (27%) patients who were radiotherapy naive. White-matter hyperintensities and global cortical atrophy were associated with worse cognitive functioning in several domains.
Interpretation: Long-term survivors of LGG who did not have radiotherapy had stable radiological and cognitive status. By contrast, patients with low-grade glioma who received radiotherapy showed a progressive decline in attentional functioning, even those who received fraction doses that are regarded as safe (=2 Gy). These cognitive deficits are associated with radiological abnormalities. Our results suggest that the risk of long-term cognitive and radiological compromise that is associated with radiotherapy should be considered when treatment is planned.
Funding: Kaptein Fonds; Schering Plough.
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http://dx.doi.org/10.1016/S1474-4422(09)70204-2 | DOI Listing |
Radiother Oncol
December 2024
Department of Oncology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway. Electronic address:
Background And Purpose: We lack population-based data on the use and effectiveness of phosphodiesterase- 5inhibitors (PDE-5Is) in post-radiotherapy long-term prostate cancer survivors (PCaSs). In this cross-sectional survey performed 9 years after curative radiotherapy we explored PDE-5I use and the drugs'effectiveness in 1,092 nine-year PCaSs responding to the sexual items of EPIC-26. The findings from PCaSs were compared to those from 2,847 age-similar men from the general population (Norms).
View Article and Find Full Text PDFRadiography (Lond)
December 2024
Newcastle Upon Tyne Hospitals NHS Foundation Trust, Northern Centre for Cancer Care, Newcastle Upon Tyne, United Kingdom; Newcastle University, Translational and Clinical Research Institute, Newcastle Upon Tyne, United Kingdom.
Purpose/objective: MR-only radiotherapy planning exploits the benefits of MRI soft-tissue delineation, whilst negating the registration inaccuracies caused by MRI CT fusion. Fiducial markers have conventionally been used in prostate radiotherapy to reduce on-treatment image matching variability. However, this is an invasive procedure for the patient, and presents technical difficulties in an MR-only pathway as fiducial markers are difficult to visualise on MRI.
View Article and Find Full Text PDFInt J Surg Case Rep
December 2024
Department of Internal medicine, Hawassa University Comprehensive Specialized Hospital, Hawassa, Sidama, Ethiopia.
Introduction And Importance: Chordoma is an uncommon malignant tumor that originates from the remnants of the primitive notochord in the embryo. They account for 1 % of intracranial tumors and 4 % of primary bone tumors. It is a locally aggressive tumor with a low risk of metastasis.
View Article and Find Full Text PDFAnn Hematol
December 2024
Department of Medical Oncology, Hebei Key Laboratory of Cancer Radiotherapy and Chemotherapy, Affiliated Hospital of Hebei University, 212 Yuhua East Road, Baoding, 071000, Hebei, China.
The first-line treatment for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) has recently undergone major changes, and targeted therapies have ushered in a new era of CLL/SLL treatment. Scientists in different countries have successively analyzed the efficacy of various drugs, but safety studies are relatively insufficient. Therefore, this systematic evaluation and retrospective meta-analysis was conducted to compare the differences in adverse effects and their incidence among first-line treatment regimens for CLL/SLL.
View Article and Find Full Text PDFAnn Med
December 2025
Department of Hematology, Affiliated Hangzhou First People's Hospital, Westlake University, School of Medicine, Hangzhou, China.
Background: The management of high-risk acute myeloid leukaemia (AML) remains challenging, highlighting the need for innovative conditioning strategies beyond current regimens.
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