Effects of brain radiotherapy on cognitive performance in adult low-grade glioma patients: A systematic review. (July 2021)

• Record Type: Journal Article
• Authors: Koutsarnakis, Christos; Neromyliotis, Eleftherios; Komaitis, Spyridon; Mazarakis, Nektarios; O'Hara, Daniel J.; Stranjalis, Georgios; Chumas, Paul
• Is Part Of: Radiotherapy and oncology. Volume 160(2021)
• Page Start: 202
• Page End: 211
• Publication Date: 2021-07
• Subjects: Low grade gliomas -- Radiation therapy -- Adults -- Cognitive deficit -- Quality of Life -- Grade II gliomas; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2021.04.023
• Languages: English
• ISSNs: 0167-8140

Abstract

Highlights: No hard data links radiotherapy with cognitive decline in LGG patients. Quality of evidence is low, with confounders still incompletely addressed. The main confounder is that of tumour location. Currently withholding RT from high risk LGG patients is not advisable. High quality evidence from an ongoing prospective study is expected. Abstract: Grade II gliomas are slow growing tumours that usually affect younger patients. The mainstream treatment modality at present is surgical. The role of radiation therapy in the management of grade II gliomas has been the subject of considerable debate. Radiation therapy has a proven potential to prolong progression free and overall survival in high-risk patients, but may also produce long-term cognitive deficits. Since grade II glioma patients are expected to live several years, retention of cognitive capacity and quality of life is an equally important endpoint as prolonging progression free survival. Our overarching goal is to critically review the available evidence on the possible neuropsychological effects of postoperative radiotherapy in adult grade II glioma patients. We performed a systematic literature search in Medline, Embase and Cochrane databases up to 1st of May 2020 for studies assessing the cognitive effects of radiation therapy on grade II glioma patients. Eleven studies meeting our inclusion criteria provide either negative or contradictory data regarding the cognitive domains affected, while major confounding variables remain incompletely addressed. The available evidence does not adequately support the notion that current radiation therapy protocols independently produce substantial cognitive decline in grade II glioma patients and therefore it would be premature to argue that radiation associated cognitive morbidity outweighs the benefit of prolonged survival. A large prospective study incorporating a full battery of neuropsychological testing, sufficiently long-term follow-up period and tight control of confounders is due to provide high quality data.