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Nisanova A, Parajuli A, Antony B, Aboud O, Sun J, Daly ME, Fragoso RC, Yiu G, Liu YA. Retinal Microstructural Changes Reflecting Treatment-Associated Cognitive Dysfunction in Patients with Lower-Grade Gliomas. OPHTHALMOLOGY SCIENCE 2024; 4:100577. [PMID: 39263578 PMCID: PMC11388696 DOI: 10.1016/j.xops.2024.100577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 09/13/2024]
Abstract
Purpose To determine whether microstructural retinal changes, tumor features, and apolipoprotein E (APOE) ε4 polymorphism are correlated with clinically detectable treatment-associated cognitive dysfunction (TACD) in patients with lower-grade gliomas. Design Cohort study. Participants and Controls Sixteen patients with lower-grade glioma at a United States academic ophthalmology department between January 2021 and November 2023. Normal controls were recruited from convenient sampling. Methods Montreal Cognitive Assessment (MoCA) scores and retinal changes were assessed in 6-month intervals. Apolipoprotein E genotyping was performed, and tumor details were recorded. Partial least-squares discriminant (PLSD) model was established to evaluate the association between TACD with APOE genotype, ophthalmic, and tumor features. Main Outcome Measures The main outcome measure was cognitive status as measured by the MoCA score and analyzed in relation to ophthalmic measurements, tumor features, and APOE genotype. Results Median time to first eye examination was 34 months (2-266) from tumor diagnosis and 23 months (0-246) from radiation. Nine patients (56%) had abnormal cognition (MoCA <26/30). Montreal Cognitive Assessment scores were significantly worse in patients with temporal (22 ± 7.2) than frontal lobe tumors (26 ± 3.1, P = 0.02) and those with oligodendrogliomas (22 ± 4.1) than astrocytomas (26 ± 3.6, = 0.02). Patients with TACD had significant radial peripapillary capillary density loss (45% ± 4.6) compared with those with normal cognition (49% ± 2.6, P = 0.02). A PLSD model correlated MoCA scores with retinal nerve fiber thickness, intraocular pressure, foveal avascular zone, best-corrected visual acuity, months since first diagnosis, and tumor pathology (oligodendroglioma or not). Using these features, the model identified patients with TACD with 77% accuracy. Apolipoprotein E genotyping showed: 2 ε2/ε3 (13%), 10 ε3/ε3 (63%), and 1 ε3/ε4 (6%). Conclusions Retinal microstructural changes may serve as biomarkers for TACD in patients with lower-grade gliomas. Temporal lobe tumors and oligodendrogliomas may increase susceptibility to TACD. Utilization of retinal markers may enhance TACD diagnosis, progression monitoring, and inform management of lower-grade patients with glioma. A larger study with serial eye examinations is warranted to evaluate the role of APOE ε4 and develop a predictive model. Financial Disclosures Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Arina Nisanova
- Department of Ophthalmology & Vision Science, University of California Davis, Sacramento, California
| | - Ashutosh Parajuli
- Institute of Innovation, Science & Sustainability, Federation University Australia, Ballart, Victoria, Australia
| | - Bhavna Antony
- Institute of Innovation, Science & Sustainability, Federation University Australia, Ballart, Victoria, Australia
| | - Orwa Aboud
- Department of Neurological Surgery, University of California Davis, Sacramento, California
- Department of Neurology, University of California Davis, Sacramento, California
| | - Jinger Sun
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Megan E Daly
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Ruben C Fragoso
- Department of Radiation Oncology, University of California Davis, Sacramento, California
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California Davis, Sacramento, California
| | - Yin Allison Liu
- Department of Ophthalmology & Vision Science, University of California Davis, Sacramento, California
- Department of Neurological Surgery, University of California Davis, Sacramento, California
- Department of Neurology, University of California Davis, Sacramento, California
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Barone TA, Robinson DL, Qiu J, Gurova KV, Purmal AA, Gudkov AV, Plunkett RJ. FACT inhibitor CBL0137, administered in an optimized schedule, potentiates radiation therapy for glioblastoma by suppressing DNA damage repair. J Neurooncol 2024:10.1007/s11060-024-04819-8. [PMID: 39251545 DOI: 10.1007/s11060-024-04819-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2024] [Accepted: 08/30/2024] [Indexed: 09/11/2024]
Abstract
PURPOSE Standard-of-care for glioblastoma remains surgical debulking followed by temozolomide and radiation. However, many tumors become radio-resistant while radiation damages surrounding brain tissue. Novel therapies are needed to increase the effectiveness of radiation and reduce the required radiation dose. Drug candidate CBL0137 is efficacious against glioblastoma by inhibiting histone chaperone FACT, known to be involved in DNA damage repair. We investigated the combination of CBL0137 and radiation on glioblastoma. METHODS In vitro, we combined CBL0137 with radiation on U87MG and A1207 glioblastoma cells using the clonogenic assay to evaluate the response to several treatment regimens, and the Fast Halo Assay to examine DNA repair. In vivo, we used the optimum combination treatment regimen to evaluate the response of orthotopic tumors in nude mice. RESULTS In vitro, the combination of CBL0137 and radiation is superior to either alone and administering CBL0137 two hours prior to radiation, having the drug present during and for a prolonged period post-radiation, is an optimal schedule. CBL0137 inhibits DNA damage repair following radiation and affects the subcellular distribution of histone chaperone ATRX, a molecule involved in DNA repair. In vivo, one dose of CBL0137 is efficacious and the combination of CBL0137 with radiation increases median survival over either monotherapy. CONCLUSIONS CBL0137 is most effective with radiation for glioblastoma when present at the time of radiation, immediately after and for a prolonged period post-radiation, by inhibiting DNA repair caused by radiation. The combination leads to increased survival making it attractive as a dual therapy.
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Affiliation(s)
- Tara A Barone
- Department of Neuro-Oncology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA.
| | - Denisha L Robinson
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Jingxin Qiu
- Department of Pathology and Laboratory Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Katerina V Gurova
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Andrei V Gudkov
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Robert J Plunkett
- Department of Neuro-Oncology, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, USA
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Barone TA, Robinson DL, Qiu J, Gurova KV, Purmal AA, Gudkov AV, Plunkett RJ. FACT inhibitor CBL0137, administered in an optimized schedule, potentiates radiation therapy for glioblastoma by suppressing DNA damage repair. RESEARCH SQUARE 2024:rs.3.rs-4830689. [PMID: 39315270 PMCID: PMC11419263 DOI: 10.21203/rs.3.rs-4830689/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Purpose Standard-of-care for glioblastoma remains surgical debulking followed by temozolomide and radiation. However, many tumors become radio-resistant while radiation damages surrounding brain tissue. Novel therapies are needed to increase the effectiveness of radiation and reduce the required radiation dose. Drug candidate CBL0137 is efficacious against glioblastoma by inhibiting histone chaperone FACT, known to be involved in DNA damage repair. We investigated the combination of CBL0137 and radiation on glioblastoma. Methods In vitro , we combined CBL0137 with radiation on U87MG and A1207 glioblastoma cells using the clonogenic assay to evaluate the response to several treatment regimens, and the Fast Halo Assay to examine DNA repair. In vivo, we used the optimum combination treatment regimen to evaluate the response of orthotopic tumors in nude mice. Results In vitro , the combination of CBL0137 and radiation is superior to either alone and administering CBL0137 two hours prior to radiation, having the drug present during and for a prolonged period post-radiation, is an optimal schedule. CBL0137 inhibits DNA damage repair following radiation and affects the subcellular distribution of histone chaperone ATRX, a molecule involved in DNA repair. In vivo , one dose of CBL0137 is efficacious and the combination of CBL0137 with radiation increases median survival over either monotherapy. Conclusions CBL0137 is most effective with radiation for glioblastoma when present at the time of radiation, immediately after and for a prolonged period post-radiation, by inhibiting DNA repair caused by radiation. The combination leads to increased survival making it attractive as a dual therapy.
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Cho NS, Wang C, Van Dyk K, Sanvito F, Oshima S, Yao J, Lai A, Salamon N, Cloughesy TF, Nghiemphu PL, Ellingson BM. Pseudo-Resting-State Functional MRI Derived from Dynamic Susceptibility Contrast Perfusion MRI Can Predict Cognitive Impairment in Glioma. AJNR Am J Neuroradiol 2024:ajnr.A8327. [PMID: 38719607 DOI: 10.3174/ajnr.a8327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/01/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND AND PURPOSE Resting-state functional MRI (rs-fMRI) can be used to estimate functional connectivity (FC) between different brain regions, which may be of value for identifying cognitive impairment in patients with brain tumors. Unfortunately, neither rs-fMRI nor neurocognitive assessments are routinely assessed clinically, mostly due to limitations in examination time and cost. Since DSC perfusion MRI is often used clinically to assess tumor vascularity and similarly uses a gradient-echo-EPI sequence for T2*-sensitivity, we theorized a "pseudo-rs-fMRI" signal could be derived from DSC perfusion to simultaneously quantify FC and perfusion metrics, and these metrics can be used to estimate cognitive impairment in patients with brain tumors. MATERIALS AND METHODS Twenty-four consecutive patients with gliomas were enrolled in a prospective study that included DSC perfusion MRI, resting-sate functional MRI (rs-fMRI), and neurocognitive assessment. Voxelwise modeling of contrast bolus dynamics during DSC acquisition was performed and then subtracted from the original signal to generate a residual "pseudo-rs-fMRI" signal. Following the preprocessing of pseudo-rs-fMRI, full rs-fMRI, and a truncated version of the full rs-fMRI (first 100 timepoints) data, the default mode, motor, and language network maps were generated with atlas-based ROIs, Dice scores were calculated for the resting-state network maps from pseudo-rs-fMRI and truncated rs-fMRI using the full rs-fMRI maps as reference. Seed-to-voxel and ROI-to-ROI analyses were performed to assess FC differences between cognitively impaired and nonimpaired patients. RESULTS Dice scores for the group-level and patient-level (mean±SD) default mode, motor, and language network maps using pseudo-rs-fMRI were 0.905/0.689 ± 0.118 (group/patient), 0.973/0.730 ± 0.124, and 0.935/0.665 ± 0.142, respectively. There was no significant difference in Dice scores between pseudo-rs-fMRI and the truncated rs-fMRI default mode (P = .97) or language networks (P = .30), but there was a difference in motor networks (P = .02). A multiple logistic regression classifier applied to ROI-to-ROI FC networks using pseudo-rs-fMRI could identify cognitively impaired patients (sensitivity = 84.6%, specificity = 63.6%, receiver operating characteristic area under the curve (AUC) = 0.7762 ± 0.0954 (standard error), P = .0221) and performance was not significantly different from full rs-fMRI predictions (AUC = 0.8881 ± 0.0733 (standard error), P = .0013, P = .29 compared with pseudo-rs-fMRI). CONCLUSIONS DSC perfusion MRI-derived pseudo-rs-fMRI data can be used to perform typical rs-fMRI FC analyses that may identify cognitive decline in patients with brain tumors while still simultaneously performing perfusion analyses.
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Affiliation(s)
- Nicholas S Cho
- From the UCLA Brain Tumor Imaging Laboratory (BTIL) (N.S.C., C.W., F.S., S.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California
- Department of Radiological Sciences (N.S.C., C.W., F.S., S.O., J.Y., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
- Department of Bioengineering (N.S.C., B.M.E.), Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, California
- Medical Scientist Training Program (N.S.C.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Chencai Wang
- From the UCLA Brain Tumor Imaging Laboratory (BTIL) (N.S.C., C.W., F.S., S.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California
- Department of Radiological Sciences (N.S.C., C.W., F.S., S.O., J.Y., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Kathleen Van Dyk
- Department of Psychiatry and Biobehavioral Sciences (K.V.D, B.M.E.), David Geffen School of Medicine, Semel Institute, University of California Los Angeles, Los Angeles, California
| | - Francesco Sanvito
- From the UCLA Brain Tumor Imaging Laboratory (BTIL) (N.S.C., C.W., F.S., S.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California
- Department of Radiological Sciences (N.S.C., C.W., F.S., S.O., J.Y., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sonoko Oshima
- From the UCLA Brain Tumor Imaging Laboratory (BTIL) (N.S.C., C.W., F.S., S.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California
- Department of Radiological Sciences (N.S.C., C.W., F.S., S.O., J.Y., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Jingwen Yao
- From the UCLA Brain Tumor Imaging Laboratory (BTIL) (N.S.C., C.W., F.S., S.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California
- Department of Radiological Sciences (N.S.C., C.W., F.S., S.O., J.Y., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Albert Lai
- UCLA Neuro-Oncology Program (A.L., T.F.C., P.L.N.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
- Department of Neurology (A.L., T.F.C., P.L.N.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Noriko Salamon
- Department of Radiological Sciences (N.S.C., C.W., F.S., S.O., J.Y., N.S., B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Timothy F Cloughesy
- UCLA Neuro-Oncology Program (A.L., T.F.C., P.L.N.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
- Department of Neurology (A.L., T.F.C., P.L.N.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Phioanh L Nghiemphu
- UCLA Neuro-Oncology Program (A.L., T.F.C., P.L.N.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
- Department of Neurology (A.L., T.F.C., P.L.N.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Benjamin M Ellingson
- From the UCLA Brain Tumor Imaging Laboratory (BTIL) (N.S.C., C.W., F.S., S.O., J.Y., B.M.E.), Center for Computer Vision and Imaging Biomarkers, University of California, Los Angeles, Los Angeles, California
- Department of Bioengineering (N.S.C., B.M.E.), Henry Samueli School of Engineering and Applied Science, University of California, Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences (K.V.D, B.M.E.), David Geffen School of Medicine, Semel Institute, University of California Los Angeles, Los Angeles, California
- Department of Neurosurgery (B.M.E.), David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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Spoor JKH, Donders-Kamphuis M, Veenstra WS, van Dijk SA, Dirven CMF, Sillevis Smitt PAE, van den Bent MJ, Leenstra S, Satoer DD. Cognition and health-related quality of life in long-term survivors of high-grade glioma: an interactive perspective from patient and caregiver. Acta Neurochir (Wien) 2024; 166:166. [PMID: 38565800 PMCID: PMC10987343 DOI: 10.1007/s00701-024-06037-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND The health-related quality of life (HRQoL) and cognition are important indicators for the quality of survival in patients with high-grade glioma (HGG). However, data on long-term survivors and their caregivers are scarce. We aim to investigate the interaction between cognition and HRQoL in long-term survivors, their caregivers' evaluations, and the effect on caregiver strain and burden. METHODS 21 long-term HGG (8 WHO grade III and 13 WHO grade IV) survivors (survival ≥ 5 years) and 15 caregivers were included. Cognition (verbal memory, attention, executive functioning, and language), HRQoL, anxiety and depression, caregiver strain, and caregiver burden were assessed with standardized measures. Questionnaires were completed by patients and/or their caregivers. RESULTS Mean survival was 12 years (grade III) and 8 years (grade IV). Cognition was significantly impaired with a large individual variety. Patients' general HRQoL was not impaired but all functioning scales were deviant. Patient-proxy agreement was found in most HRQoL subscales. Three patients (14%) showed indications of anxiety or depression. One-third of the caregivers reported a high caregiver strain or a high burden. Test scores for attention, executive functioning, language, and/or verbal memory were correlated with perceived global health status, cognitive functioning, and/or communication deficits. Caregiver burden was not related to cognitive deficits. CONCLUSIONS In long-term HGG survivors maintained HRQoL seems possible even when cognition is impaired in a large variety at the individual level. A tailored approach is therefore recommended to investigate the cognitive impairments and HRQoL in patients and the need for patient and caregiver support.
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Affiliation(s)
- Jochem K H Spoor
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands.
| | - Marike Donders-Kamphuis
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
- HMC, Department of Neurosurgery, The Hague, The Netherlands
| | - Wencke S Veenstra
- Department of Rehabilitation Medicine, Center for Rehabilitation - University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sarah A van Dijk
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Clemens M F Dirven
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Peter A E Sillevis Smitt
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Martin J van den Bent
- Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sieger Leenstra
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Djaina D Satoer
- Department of Neurosurgery, Erasmus MC - University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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Mitra S, Dash R, Munni YA, Selsi NJ, Akter N, Uddin MN, Mazumder K, Moon IS. Natural Products Targeting Hsp90 for a Concurrent Strategy in Glioblastoma and Neurodegeneration. Metabolites 2022; 12:1153. [PMID: 36422293 PMCID: PMC9697676 DOI: 10.3390/metabo12111153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 09/16/2023] Open
Abstract
Glioblastoma multiforme (GBM) is one of the most common aggressive, resistant, and invasive primary brain tumors that share neurodegenerative actions, resembling many neurodegenerative diseases. Although multiple conventional approaches, including chemoradiation, are more frequent in GBM therapy, these approaches are ineffective in extending the mean survival rate and are associated with various side effects, including neurodegeneration. This review proposes an alternative strategy for managing GBM and neurodegeneration by targeting heat shock protein 90 (Hsp90). Hsp90 is a well-known molecular chaperone that plays essential roles in maintaining and stabilizing protein folding to degradation in protein homeostasis and modulates signaling in cancer and neurodegeneration by regulating many client protein substrates. The therapeutic benefits of Hsp90 inhibition are well-known for several malignancies, and recent evidence highlights that Hsp90 inhibitors potentially inhibit the aggressiveness of GBM, increasing the sensitivity of conventional treatment and providing neuroprotection in various neurodegenerative diseases. Herein, the overview of Hsp90 modulation in GBM and neurodegeneration progress has been discussed with a summary of recent outcomes on Hsp90 inhibition in various GBM models and neurodegeneration. Particular emphasis is also given to natural Hsp90 inhibitors that have been evidenced to show dual protection in both GBM and neurodegeneration.
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Affiliation(s)
- Sarmistha Mitra
- Department of Anatomy, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea
| | - Raju Dash
- Department of Anatomy, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea
| | - Yeasmin Akter Munni
- Department of Anatomy, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea
| | - Nusrat Jahan Selsi
- Product Development Department, Popular Pharmaceuticals Ltd., Dhaka 1207, Bangladesh
| | - Nasrin Akter
- Department of Clinical Pharmacy and Molecular Pharmacology, East West University Bangladesh, Dhaka 1212, Bangladesh
| | - Md Nazim Uddin
- Department of Pharmacy, Southern University Bangladesh, Chittagong 4000, Bangladesh
| | - Kishor Mazumder
- Department of Pharmacy, Jashore University of Science and Technology, Jashore 7408, Bangladesh
- School of Optometry and Vision Science, UNSW Medicine, University of New South Wales (UNSW), Sydney, NSW 2052, Australia
| | - Il Soo Moon
- Department of Anatomy, Dongguk University College of Medicine, Gyeongju 38066, Republic of Korea
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Pertz M, Kowalski T, Jetschke K, Schmieder K, Schlegel U, Miller D. Pre- and postoperative self-reported and objectively assessed neurocognitive functioning in lower grade glioma patients. J Clin Neurosci 2022; 106:185-193. [DOI: 10.1016/j.jocn.2022.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 10/03/2022] [Accepted: 10/28/2022] [Indexed: 11/09/2022]
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Alves CHL, Alves GS, Ferreira AAMF, Lacerda EMDCB, Tomaz C. Cognitive evaluation following the evolution of brain myofibroblastic tumor in the adolescence: a case study report. JORNAL BRASILEIRO DE PSIQUIATRIA 2022. [DOI: 10.1590/0047-2085000000382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACT Objective To report the case of a teenager (12 years old) diagnosed with a brain tumor in the right frontal-parietal region emphasizing the main characteristics observed in neuropsychological examinations. Methods In the pre-surgical evaluation, the patient presented behavioral alterations, including deficits in verbal comprehension, perceptual organization, working memory, processing speed, and slight alterations regarding constructive praxis. Results A reevaluation after two years surgery revealed significant improvement in verbal and perceptual comprehension and constructive praxis while remaining a slight change in processing speed. These results suggest that the tumor’s surgical resection produced significant improvements in the patient’s neurocognitive context, especially in executive functions. This study also indicates that Neuropsychological evaluation are useful for pre- and post- surgical evaluation of cognitive functioning and its evolution. Conclusion Brain tumor causes cognitive and behavioral changes and its resection can result in improvements in the patient’s quality of life.
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Jammula V, Rogers JL, Vera E, Christ A, Leeper HE, Acquaye A, Briceno N, Choi A, Grajkowska E, Levine J, Lindsley M, Reyes J, Roche K, Timmer M, Boris L, Burton E, Lollo N, Panzer M, Smith-Cohn MA, Penas-Prado M, Pillai V, Theeler BJ, Wu J, Gilbert MR, Armstrong TS. The Montreal Cognitive Assessment (MoCA) in Neuro-Oncology: A Pilot Study of Feasibility and Utility in Telehealth and In-Person Clinical Assessments. Neurooncol Pract 2022; 9:429-440. [PMID: 36124322 PMCID: PMC9384084 DOI: 10.1093/nop/npac038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cognitive impairments are a common burden for patients with primary CNS tumors. Neuropsychological assessment batteries can be too lengthy, which limits their use as an objective measure of cognition during routine care. The purpose of this study was to evaluate the feasibility and utility of the brief Montreal Cognitive Assessment (MoCA) in routine in-person and telehealth visits (as a result of the global COVID-19 pandemic) with neuro-oncology patients.
Methods
71 adults with primary CNS tumors completed MoCA testing in-person (n=47) and via telehealth (n=24). Patient-reported outcomes (PROs), including symptom burden and interference, perceived cognition, general health status, and anxiety and depression, were and correlation analysis were included in this study. Feasibility was assessed through a provider satisfaction questionnaire.
Results
Patients were primarily White (83%), college-educated (71%) males (54%) with high grade tumors (66%). The average total score on the MoCA administered in-person was 25 (range: 6-30), with 34% classified as abnormal, and the average total score via telehealth was 26 (range: 12-30), with 29% classified as abnormal. Providers reported satisfaction in using the MoCA during routine clinical care, both in-person and via telehealth. Lower MoCA scores correlated with worse symptom severity, KPS, age, education, and previous treatment.
Conclusions
The MoCA was feasible in clinical and telehealth settings, and its relationship to clinical characteristics and PROs highlight the need for both objective and patient-reported measures of cognition to understand the overall cognitive profile of a patient with a CNS tumor.
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Affiliation(s)
- Varna Jammula
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - James L Rogers
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Elizabeth Vera
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alexa Christ
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Heather E Leeper
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Alvina Acquaye
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Briceno
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anna Choi
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ewa Grajkowska
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jason Levine
- Office of Information Technology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew Lindsley
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jennifer Reyes
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kayla Roche
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Timmer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Boris
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eric Burton
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Nicole Lollo
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marissa Panzer
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Matthew A Smith-Cohn
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Marta Penas-Prado
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Valentina Pillai
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Brett J Theeler
- Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jing Wu
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Mark R Gilbert
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Terri S Armstrong
- Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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10
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Braun SE, Lanoye A, Aslanzadeh FJ, Loughan AR. Subjective executive dysfunction in patients with primary brain tumors and their informants: relationships with neurocognitive, psychological, and daily functioning. Brain Inj 2021; 35:1665-1673. [PMID: 34874214 DOI: 10.1080/02699052.2021.2008492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We assessed agreement between patient- and informant-report on the Behavior Rating Inventory of Executive Function - Adult (BRIEF-A) in patients with primary brain tumors (PBT) and differences on BRIEF-A in neurocognitive (intact v. impaired), psychological (asymptomatic v. distressed), and functional (independent v. dependent) categories using both patient- and informant-report. METHOD PBT patients (n = 102) completed neuropsychological evaluations including the BRIEF-A, clinical interview, neurocognitive tests, and mood questionnaires. Correlations between the BRIEF-A and Informant (n = 39) were conducted. Differences in patient and informant BRIEF-A indices were investigated across five classifications: neurocognitive functioning, psychological functioning, medication management, appointment management, and finance management. RESULTS Patient and informant BRIEF were correlated. There was no difference on BRIEF-A or Informant indices for intact v. impaired neurocognitive status. Higher BRIEF-A and Informant indices were observed among psychologically distressed v. asymptomatic patients. Results showed higher BRIEF indices among those requiring assistance with medication, appointments, and finances. CONCLUSIONS Patients and informants agreed in their reports of executive function (EF). These reports, while not different in neurocognitive classification, were different in psychological functioning and in those needing assistance with instrumental activities of daily living (IADL). Patient- and informant-reported EF may provide important data regarding psychological and IADL functioning in this population.
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Affiliation(s)
- Sarah Ellen Braun
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA.,Massey Cancer Center, Richmond, Virginia, USA
| | - Autumn Lanoye
- Massey Cancer Center, Richmond, Virginia, USA.,Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Farah J Aslanzadeh
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ashlee R Loughan
- Department of Neurology, Virginia Commonwealth University, Richmond, Virginia, USA.,Massey Cancer Center, Richmond, Virginia, USA
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11
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Field KM, Barnes EH, Sim HW, Nowak AK, Simes J, Rosenthal MA, Wheeler H, Hovey EJ, Cher LM. Outcomes from the use of computerized neurocognitive testing in a recurrent glioblastoma clinical trial. J Clin Neurosci 2021; 94:321-327. [PMID: 34863458 DOI: 10.1016/j.jocn.2021.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/01/2021] [Accepted: 10/22/2021] [Indexed: 10/19/2022]
Abstract
Assessment of neurocognitive function (NCF) is important in brain tumor clinical trials, however there are varying methodologies available. We used the Cogstate computerized NCF testing battery and the mini-mental state examination (MMSE) to prospectively assess cognition in adult patients with recurrent glioblastoma (GBM) enrolled in the CABARET randomized phase II clinical trial of bevacizumab versus bevacizumab plus carboplatin chemotherapy. We determined completion rates; compared NCF results between trial arms; and assessed baseline NCF as a predictor of survival outcome. 93 of 103 eligible patients completed baseline Cogstate NCF testing. Completion rates were between 60 and 100% across each timepoint, and 38% at disease progression. There was no evidence of difference between arms in time to deterioration in NCF using either test. Prior to disease progression, deterioration on the Cogstate tests was substantially more common (90%) than deterioration on the MMSE (37%), and decline in the Cogstate composite score within the first 8 weeks was associated with shorter overall survival. This testing methodology may be useful when determining net clinical benefit for therapies in patients with recurrent GBM.
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Affiliation(s)
- K M Field
- Department of Medical Oncology, Royal Melbourne Hospital, Grattan St, Parkville, Vic 3050, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Grattan St, Parkville, Vic 3000, Australia.
| | - E H Barnes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, NSW 2006, Australia
| | - H W Sim
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, NSW 2006, Australia
| | - A K Nowak
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands, WA 6009, Australia; School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, WA 6009, Australia
| | - J Simes
- National Health and Medical Research Council Clinical Trials Centre, University of Sydney, NSW 2006, Australia
| | - M A Rosenthal
- Department of Medical Oncology, Royal Melbourne Hospital, Grattan St, Parkville, Vic 3050, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, Grattan St, Parkville, Vic 3000, Australia
| | - H Wheeler
- Department of Medical Oncology, Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia
| | - E J Hovey
- Department of Medical Oncology, Prince of Wales Hospital, Barker Street, Randwick, NSW 2031, Australia
| | - L M Cher
- Department of Neurology, Austin Health, 145 Studley Road, Heidelberg, Vic 3084, Australia
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12
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Almahariq MF, Quinn TJ, Arden JD, Roskos PT, Wilson GD, Marples B, Grills IS, Chen PY, Krauss DJ, Chinnaiyan P, Dilworth JT. Pulsed radiation therapy for the treatment of newly diagnosed glioblastoma. Neuro Oncol 2021; 23:447-456. [PMID: 32658268 DOI: 10.1093/neuonc/noaa165] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Pulsed radiation therapy (PRT) has shown effective tumor control and superior normal-tissue sparing ability compared with standard radiotherapy (SRT) in preclinical models and retrospective clinical series. This is the first prospective trial to investigate PRT in the treatment of patients with newly diagnosed glioblastoma (GBM). METHODS This is a single-arm, prospective study. Patients with newly diagnosed GBM underwent surgery, followed by 60 Gy of PRT with concurrent temozolomide (TMZ). Each day, a 2-Gy fraction was divided into ten 0.2-Gy pulses, separated by 3-minute intervals. Patients received maintenance TMZ. Neurocognitive function (NCF) and quality of life (QoL) were monitored for 2 years using the Hopkins Verbal Learning Test‒Revised and the European Organisation for Research and Treatment of Cancer QLQ-C30 QoL questionnaire. Change in NCF was evaluated based on a minimal clinically important difference (MCID) threshold of 0.5 standard deviation. RESULTS Twenty patients were enrolled with a median follow-up of 21 months. Median age was 60 years. Forty percent underwent subtotal resection, and 60% underwent gross total resection. One patient had an isocitrate dehydrogenase (IDH)-mutated tumor. Median progression-free survival (PFS) and overall survival (OS) were 10.7 and 20.9 months, respectively. In a post-hoc comparison, median OS for the prospective cohort was longer, compared with a matched cohort receiving SRT (20.9 vs 14 mo, P = 0.042). There was no decline in QoL, and changes in NCF scores did not meet the threshold of an MCID. CONCLUSIONS Treatment of newly diagnosed GBM with PRT is feasible and produces promising effectiveness while maintaining neurocognitive function and QoL. Validation of our results in a larger prospective trial warrants consideration.
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Affiliation(s)
| | - Thomas J Quinn
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - Jessica D Arden
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
| | - P T Roskos
- Neuropsychology Services, Department of Physical Medicine and Rehabilitation, Beaumont Health, Dearborn, Michigan
| | - George D Wilson
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Brian Marples
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Inga S Grills
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Peter Y Chen
- Department of Radiation Oncology, Beaumont Health, Royal Oak, Michigan
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Daniel J Krauss
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Prakash Chinnaiyan
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
| | - Joshua T Dilworth
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan
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13
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Valiyaveettil D, G A, Malik M, Eaga P, Ahmed SF, Joseph D. "A prospective study of assessment of neurocognitive function in illiterate patients with gliomas treated with chemoradiation": Assessment of neurocognitive function in gliomas. Cancer Treat Res Commun 2020; 26:100288. [PMID: 33352469 DOI: 10.1016/j.ctarc.2020.100288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/16/2020] [Accepted: 11/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Neurocognitive functioning (NCF) is an important component of quality of life (QoL) in glioma patients. The neurocognitive toxicity from irradiation of brain tumours may be related to damage to neural progenitor cells (NPC). The aim of our study was to assess the NCF in illiterate glioma patients. METHODS This was a prospective study done in glioma patients admitted for adjuvant treatment. Illiterate and semiliterate post op glioma patients with ECOG PS ≤ 3 were included. Neurocognitive assessment was done using Addenbrooke's Cognitive Examination (ACE-III) questionnaire prior to the start of RT and at 6month and 12 month follow up. The scores were correlated to the doses to sub ventricular zone (SVZ) and sub granular zone (SGZ) regions. RESULTS 20 patients were recruited.16 patients were illiterate and four patients were semiliterate. Median of the mean dose to the SVZ I/L (ipsilateral) was 48.5 Gy and SGZ I/L was 39.5 Gy. In patients who received ≤49 Gy mean dose to SVZ I/L, there was statistically significant improvement in memory, fluency, language and total ACE scores at six months. In patients with SGZ I/L mean dose ≤40 Gy, there was improvement in memory, language, and total ACE score at six months. Similar trend continued at 12 months follow up. CONCLUSIONS NCF assessment by ACE III questionnaire is a useful tool even in illiterate patients. Lower RT doses to the ipsilateral SVZ and SGZ showed significant improvement in total ACE scores at 6 months and improvement in specific domains at 6 and 12 months.
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Affiliation(s)
- Deepthi Valiyaveettil
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Ashalatha G
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Monica Malik
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India.
| | | | - Syed Fayaz Ahmed
- Department of Radiation Oncology, Nizam's Institute of Medical Sciences, Hyderabad, India
| | - Deepa Joseph
- All India Institute of Medical Sciences, Rishikesh, India
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14
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Jaywant A, Steinberg C, Lee A, Toglia J. Feasibility and acceptability of the multicontext approach for individuals with acquired brain injury in acute inpatient rehabilitation: A single case series. Neuropsychol Rehabil 2020; 32:211-230. [PMID: 32873157 DOI: 10.1080/09602011.2020.1810710] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Multicontext (MC) approach, a metacognitive intervention designed to improve awareness, strategy use, and executive functioning, may be beneficial for individuals with acquired brain injury (ABI) undergoing acute inpatient rehabilitation. The goal of this study was to provide evidence of feasibility and acceptability of the MC approach and to explore clinical outcomes. A case series of eight individuals with acquired brain injury and at least mild executive functioning impairment were recruited from an acute inpatient rehabilitation unit. The MC approach - involving guided questioning and patient self-generation of strategies practiced across everyday functional cognitive tasks - was implemented within routine occupational therapy. Occupational therapists implemented the MC approach with high adherence to the treatment protocol. Therapists' perceived challenges were the time constraints of inpatient rehabilitation as well as client factors. Participants rated the MC approach as highly satisfying and engaging. They described subjective improvements in their ability to use executive functioning strategies. The MC approach was associated with improvement in awareness, strategy use, and executive functioning at the conclusion of treatment. The MC approach may be a beneficial intervention for individuals with acquired brain injury and executive dysfunction undergoing acute inpatient rehabilitation. Further evaluation with larger samples in controlled trials is warranted.Trial registration: ClinicalTrials.gov identifier: NCT04363645..
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Affiliation(s)
- Abhishek Jaywant
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Alyson Lee
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Joan Toglia
- Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, NY, USA.,NewYork-Presbyterian Hospital, New York, NY, USA.,School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY, USA
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15
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De Martino M, Santini B, Cappelletti G, Mazzotta A, Rasi M, Bulgarelli G, Annicchiarico L, Marcocci A, Talacchi A. The quality of measurement properties of neurocognitive assessment in brain tumor clinical trials over the last 30 years: a COSMIN checklist-based approach. Neurol Sci 2020; 41:3105-3121. [PMID: 32656714 DOI: 10.1007/s10072-020-04477-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/20/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To provide an exhaustive review of the neuropsychological examination as conducted in brain tumor clinical trials over the last 30 years and to provide objective ratings about the reliability and suitability of such tests in neurooncological research and clinical practice. METHODS Methodologies and tools provided by the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) were exploited in order to assess the measurement properties of questionnaires and performance-based instruments used to evaluate cognitive functioning in brain tumor clinical trials from 1997 to 2017. RESULTS Twenty-six brain tumor clinical trials were analyzed and an overall set of 10 neuropsychological tests was identified. A list of 24 studies concerning the reliability of such tests was analyzed. Reliability and level of evidence scores for each study and for each test were obtained. The results revealed relevant faults about the quality of measurements and the suitability of the neurocognitive assessment batteries most commonly used in brain tumor clinical trials. CONCLUSION Our findings suggest that the cognitive assessment in brain tumor clinical trials should be implemented according to specific endpoints and should be addressed to investigate all the cognitive domains known to be affected by brain tumor and treatment.
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Affiliation(s)
- Maria De Martino
- Department of Political and Communication Sciences, University of Salerno, Via Giovanni Paolo II, 132, (SA), 84084, Fisciano, Italy.
| | - Barbara Santini
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Giovanna Cappelletti
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Annapina Mazzotta
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Matteo Rasi
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Giorgia Bulgarelli
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Luciano Annicchiarico
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Alessandro Marcocci
- Unit of Othorinolaringology, Merano Hospital, Via Rossini, 5, 39012, Merano (BZ), Italy
| | - Andrea Talacchi
- Section of Neurosurgery, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
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16
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Pertz M, Popkirov S, Schlegel U, Thoma P. Research on cognitive and sociocognitive functions in patients with brain tumours: a bibliometric analysis and visualization of the scientific landscape. Neurol Sci 2020; 41:1437-1449. [PMID: 32052308 PMCID: PMC8266703 DOI: 10.1007/s10072-020-04276-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 02/02/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Many patients with brain tumours exhibit mild to severe (neuro)cognitive impairments at some point during the course of the disease. Social cognition, as an instance of higher-order cognitive functioning, specifically enables initiation and maintenance of appropriate social interactions. For individuals being confronted with the diagnosis of a brain tumour, impairment of social function represents an additional burden, since those patients deeply depend on support and empathy provided by family, friends and caregivers. METHODS The present study explores the scientific landscape on (socio)cognitive functioning in brain tumour patients by conducting a comprehensive bibliometric analysis using VOSviewer. The Web of Science Core Collection database was examined to identify relevant documents published between 1945 and 2019. RESULTS A total of 664 English titles on (socio)cognitive functions in patients with brain tumours was retrieved. Automated textual analysis revealed that the data available so far focus on three major topics in brain tumour patients: cognitive functions in general and in paediatric cases, as well as psychological factors and their influence on quality of life. The focus of research has gradually moved from clinical studies with cognitive functions as one of the outcome measures to investigations of interactions between cognitive functions and psychological constructs such as anxiety, depression or fatigue. Medical, neurological and neuropsychological journals, in particular neuro-oncological journals published most of the relevant articles authored by a relatively small network of well interconnected researchers in the field. CONCLUSION The bibliometric analysis highlights the necessity of more research on social cognition in brain tumour patients.
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Affiliation(s)
- Milena Pertz
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany.
| | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892, Bochum, Germany
| | - Patrizia Thoma
- Neuropsychological Therapy Centre (NTC)/Clinical Neuropsychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, D-44780, Bochum, Germany
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Clinical and Biological Correlates of Preoperative Cognitive Functioning of Glioma and Meningioma Patients. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2054859. [PMID: 32461966 PMCID: PMC7232682 DOI: 10.1155/2020/2054859] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 03/31/2020] [Accepted: 04/17/2020] [Indexed: 01/13/2023]
Abstract
Objectives This study aimed to investigate the association of high-sensitivity C-reactive protein (hsCRP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) serum concentrations with cognitive functions of glioma and meningioma patients. Methods 177 brain tumor patients awaiting for brain tumor surgery participated in the study. Patients were assessed preoperatively, using neuropsychological tests for verbal memory, psychomotor speed, mental flexibility, and verbal fluency. The functional status of patients was evaluated using the Karnofsky Performance Index. Blood samples were drawn for evaluation of serum hsCRP and NT-proBNP concentrations upon hospital admission. Results The highest NT-proBNP concentration was observed in meningioma patients. Glioma and meningioma patients did not differ in hsCRB concentration. Patients in the highest hsCRP tertile were older and more frequently reported cardiovascular comorbidity. Patients in the highest NT-proBNP tertile were older, more frequently with cardiovascular comorbidity, females, and diagnosed with a meningioma. hsCRP was significantly related to slower psychomotor speed in high-grade glioma patients (rho = 0.30, p < 0.05). In meningioma sample, NT-proBNP correlated with decreased psychomotor speed (rho = 0.38, p < 0.01), mental flexibility (rho = 0.33, p < 0.01), worse cumulative learning (rho = −0.27, p < 0.05), and delayed recall (rho = 0.30, p < 0.01). However, the relationship between the NT-proBNP and cognitive functions became nonsignificant when demographic and clinical covariates were included into analysis. Higher hsCRP concentration remained significantly related to slower psychomotor speed (p = 0.02) and worse mental flexibility (p = 0.05) in glioma patients, independently from demographic and clinical covariates. Preoperative cognitive functioning was also predicted by older age, gender, side and location of the tumor, and tumor malignancy, and general functional status of a patient. Conclusions NT-proBNP was not associated with memory, language, and attention/executive cognitive domains of glioma and meningioma patients. Increased hsCRP was related to slower psychomotor speed and worse mental flexibility in glioma patients, indicating that inflammation processes are important for cognitive functioning in glial tumors.
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18
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Sensitivity of the Montreal Cognitive Assessment in screening for cognitive impairment in patients with newly diagnosed high-grade glioma. J Neurooncol 2020; 148:335-342. [PMID: 32415644 DOI: 10.1007/s11060-020-03524-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 05/02/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Cognitive impairment is frequent in patients with high-grade glioma and requires cognitive follow-up. Cognitive screening tools such as the Montreal Cognitive Assessment (MoCA) have been used to assess cognition in these patients. Here we assessed the sensitivity of the MoCA in screening for cognitive impairment in a cohort of 156 patients with newly-diagnosed high-grade glioma, after surgery and before radiochemotherapy. METHODS We assessed cognitive performance with the MoCA and a neuropsychological battery. Cognitive scores were analyzed in terms of a previously validated framework designed to control false positives and data for 1003 control participants from the GRECOGVASC study. After comparison of performance on the tests, we used stepwise logistic regression to produce a cognitive summary score from the neuropsychological battery. Then we analyzed sensitivity and specificity of the MoCA with receiver operator characteristic (ROC) curve analysis. RESULTS Both raw and adjusted MoCA scores showed only moderate sensitivity. The area under the ROC curve was 0.759 (95% CI 0.703-0.815) for the raw score and 0.788 (95% CI 0.734-0.842) for the adjusted score. Optimal discrimination was obtained with a raw score ≤ 25 (sensitivity: 0.526; specificity: 0.832; positive predictive value: 0.2; negative predictive value: 0.96) and an adjusted score - 0.603 (sensitivity: 0.716; specificity: 0.768; positive predictive value: 0.24; negative predictive value: 0.96). CONCLUSION The moderate sensitivity of MoCA indicates that it is not a suitable screening tool for detecting cognitive impairment in patients with newly-diagnosed high-grade glioma.
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19
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Neurocognitive function and quality of life after proton beam therapy for brain tumour patients. Radiother Oncol 2020; 143:108-116. [DOI: 10.1016/j.radonc.2019.12.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 11/21/2022]
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20
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Fan J, Milosevic R, Li J, Bai J, Zhang Y. The impact of neuroimaging advancement on neurocognitive evaluation in pediatric brain tumor survivors: A review. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.1177/2096595820902565] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pediatric brain tumors are a type of tumors that are commonly present in children and young adults. With the improvement of treatment, the quality of life, especially the cognitive functioning, is gaining increasingly more attention. Apart from cognitive evaluations, neuroimaging studies begin to play an important part in neurocognitive functioning investigation. In this way, the brain tissue changes caused by tumor variables (including tumor location and tumor size) and treatment variables (including surgery, chemotherapy and radiotherapy) can be detected by neuroimaging. Recent advancement of neuroimaging techniques, such as functional-MRI (fMRI) and diffusion tensor imaging (DTI), made great contributions to understanding cognitive dysfunction and quantifying the effects of tumor variables and treatment variables. In recent years, laminar-fMRI provided a potentially valuable tool for examining the exact origins of neural activity and cognitive function. On the other hand, molecular fMRI might guide diagnosis and treatment of brain disease in the future by using new biomarkers, and DTI can detect white matter changes and obtain some anatomically specific information.
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Affiliation(s)
- Juan Fan
- Yuquan Hosipital, Tsinghua University, Beijing 100040, China
| | | | - Jiefei Li
- Yuquan Hosipital, Tsinghua University, Beijing 100040, China
| | - Jianjun Bai
- Yuquan Hosipital, Tsinghua University, Beijing 100040, China
| | - Yuqi Zhang
- Yuquan Hosipital, Tsinghua University, Beijing 100040, China
- School of Medicine, Tsinghua University, Beijing 100084, China
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21
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Pertz M, Okoniewski A, Schlegel U, Thoma P. Impairment of sociocognitive functions in patients with brain tumours. Neurosci Biobehav Rev 2019; 108:370-392. [PMID: 31786319 DOI: 10.1016/j.neubiorev.2019.11.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/24/2019] [Accepted: 11/25/2019] [Indexed: 12/30/2022]
Abstract
The ability to decode mental states and to come up with effective solutions for interpersonal problems aids successful initiation and maintenance of social interactions and contributes to participation and mental health. Since these abilities of social cognition are challenged in highly demanding situations, such as diagnosis and treatment of a life-threatening illness, this article reviews the literature on emotion recognition, empathy, Theory of Mind and socially skilled behaviour in brain tumour patients. The data available suggest that patients are affected by a slight but consistent impairment of emotion recognition, empathy and Theory of Mind before and immediately after brain tumour treatment, with the degree of impairment being influenced by tumour histology and localization. Impairments mostly decrease a few months after surgery due to assumed neuroplasticity. Future research may address more complex sociocognitive functions, such as social problem solving, and may investigate to which degree sociocognitive difficulties act as risk factors for poor or failed reintegration into occupational and social life following successful brain tumour treatment.
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Affiliation(s)
- Milena Pertz
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892 Bochum, Germany.
| | - Annalena Okoniewski
- Neuropsychological Treatment Centre (NTC)/ Clinical Neuropsychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, D-44780 Bochum, Germany
| | - Uwe Schlegel
- Department of Neurology, University Hospital Knappschaftskrankenhaus, Ruhr-University Bochum, In der Schornau 23-25, D-44892 Bochum, Germany
| | - Patrizia Thoma
- Neuropsychological Treatment Centre (NTC)/ Clinical Neuropsychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstraße 150, D-44780 Bochum, Germany
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Altshuler DB, Wang L, Zhao L, Miklja Z, Linzey J, Brezzell A, Kakaizada S, Krishna S, Orringer DA, Briceño EM, Gabel N, Hervey-Jumper SL. BDNF, COMT, and DRD2 polymorphisms and ability to return to work in adult patients with low- and high-grade glioma. Neurooncol Pract 2019; 6:375-385. [PMID: 31555452 PMCID: PMC6753359 DOI: 10.1093/nop/npy059] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Cognitive and language dysfunction is common among patients with glioma and has a significant impact on survival and health-related quality of life (HRQOL). Little is known about the factors that make individual patients more or less susceptible to the cognitive sequelae of the disease. A better understanding of the individual and population characteristics related to cognitive function in glioma patients is required to appropriately stratify patients, prognosticate, and develop more efficacious treatment regimens. There is evidence that allelic variation among genes involved in neurotransmission and synaptic plasticity are related to neurocognitive performance in states of health and neurologic disease. METHODS We studied the association of single-nucleotide polymorphism variations in brain-derived neurotrophic factor (BDNF, rs6265), dopamine receptor 2 (DRD2, rs1076560), and catechol-O-methyltransferase (COMT, rs4680) with neurocognitive function and ability to return to work in glioma patients at diagnosis and at 3 months. We developed a functional score based on the number of high-performance alleles that correlates with the capacity for patients to return to work. RESULTS Patients with higher-performing alleles have better scores on neurocognitive testing with the Repeatable Battery for the Assessment of Neuropsychological Status and Stroop test, but not the Trail Making Test. CONCLUSIONS A better understanding of the genetic contributors to neurocognitive performance in glioma patients and capacity for functional recovery is necessary to develop improved treatment strategies based on patient-specific factors.
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Affiliation(s)
| | - Lin Wang
- Department of Neurosurgery, University of Michigan, Ann Arbor, USA
| | - Lili Zhao
- Department of Biostatistics, University of Michigan, Ann Arbor, USA
| | - Zachary Miklja
- Department of Neurosurgery, University of Michigan, Ann Arbor, USA
| | - Joey Linzey
- Department of Neurosurgery, University of Michigan, Ann Arbor, USA
| | - Amanda Brezzell
- Department of Neurosurgery, University of Michigan, Ann Arbor, USA
| | - Sofia Kakaizada
- Department of Neurosurgery, University of California San Francisco, USA
| | - Saritha Krishna
- Department of Neurosurgery, University of California San Francisco, USA
| | - Daniel A Orringer
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, USA
| | - Emily M Briceño
- Department of Neurosurgery, Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA
| | - Nicolette Gabel
- Department of Neurosurgery, Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, USA
| | - Shawn L Hervey-Jumper
- Department of Neurosurgery, University of Michigan, Ann Arbor, USA
- Department of Neurosurgery, University of California San Francisco, USA
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Fan J, Milosevic R, Li J, Bai J, Zhang Y. The impact of neuroimaging advancement on neurocognitive evaluation in pediatric brain tumor survivors: A review. BRAIN SCIENCE ADVANCES 2019. [DOI: 10.26599/bsa.2019.9050008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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24
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Ahles TA, Hurria A. New Challenges in Psycho-Oncology Research IV: Cognition and cancer: Conceptual and methodological issues and future directions. Psychooncology 2019; 27:3-9. [PMID: 29044730 DOI: 10.1002/pon.4564] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 09/29/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Tim A Ahles
- Department of Psychiatry and Behavioral Sciences, Neurocognitive Research Laboratory, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arti Hurria
- Center for Cancer and Aging, George Tsai Family Chair in Geriatric Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
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25
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Loughan AR, Braun SE, Lanoye A. Executive dysfunction in neuro-oncology: Behavior Rating Inventory of Executive Function in adult primary brain tumor patients. APPLIED NEUROPSYCHOLOGY-ADULT 2019; 27:393-402. [PMID: 30714410 DOI: 10.1080/23279095.2018.1553175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Adult primary brain tumor (PBT) survivors report persistent cognitive difficulties before, during, and after treatment, which are problematic for everyday functioning. Cognitive domains often affected by cancer treatment appear to be attention and executive functioning (EF). One validated measure developed to assess an individual's EF within daily living is the Behavior Rating Inventory of Executive Function-Adult (BRIEF-A). To date, no published research has investigated the EF profile of PBT patients using the BRIEF-A. Seventy-four PBT patients completed the BRIEF-A. Descriptive analyses were conducted to determine the self-reported EF profile in PBT patients. T-tests preliminarily compared the performance of PBT patients to four other comparison groups: mild cognitive impairment (MCI; n = 23), attention-deficit/hyperactivity disorder-unmedicated (ADHD-U; n = 27), traumatic brain injury (TBI; n = 23), and healthy controls (HC; n = 26). PBT BRIEF-A group means were average across subscales and indexes, yet the prevalence of significant elevations ranged from 12 to 50%. The Metacognition Index demonstrated 38% elevation prevalence compared to 22% in Behavioral Regulation. Approximately 61% of the sample had at least one clinically elevated scaled score. PBT patients reported significantly more EF impairment than HC and significantly less than ADHD-U. No significant differences were found between the PBT and MCI groups or PBT and TBI groups. Despite group means not reaching clinical impairment, a substantial proportion of patients with PBTs endorse executive dysfunction. Elevations were most prominent in metacognitive abilities over behavioral dysregulation. Notably, the EF profile of PBT patients was remarkably similar to that of MCI and TBI, increased when compared to HC, and well below ADHD-U.
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Affiliation(s)
- Ashlee R Loughan
- Department of Neurology Division of Neuro-oncology, Virginia Commonwealth University and Massey Cancer Center McGlothlin Medical Education Center, Richmond, Virginia, USA
| | - Sarah E Braun
- Department of Neurology Division of Neuro-oncology, Virginia Commonwealth University and Massey Cancer Center McGlothlin Medical Education Center, Richmond, Virginia, USA.,Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Autumn Lanoye
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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26
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Abstract
Survival alone is no longer an adequate outcome for persons with brain tumors; the quality of the survivorship experience should be viewed with equal importance. Symptom management is a significant component of quality survivorship care. Regardless of their histology, brain tumors and therapies used to treat them produce symptoms that affect an individual's ability to function in everyday life. Common symptoms include fatigue, cognitive impairment, distress, and sleep disturbance. Symptom-based interventions for persons with brain tumors focus on prevention, self-management, and prescriptive interventions targeted to these problems. Unfortunately, little evidence exists to support many interventions, making it challenging for clinicians to provide concrete recommendations. Research is needed to provide evidence in support of symptom-based interventions while novel approaches to these challenging problems are developed.
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Affiliation(s)
- Christina Amidei
- Northwestern Medicine, Neurological Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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27
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Mariani M, Collins MWG. Neuropsychological profiles of breast cancer and brain tumor cohorts in Northeast Ontario, Canada. Support Care Cancer 2018; 26:3801-3809. [PMID: 29774475 DOI: 10.1007/s00520-018-4247-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 05/06/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE As developments in cancer treatment have improved outcomes, research has increasingly focused on the role of cancer-related cognitive impairment (CRCI) in quality of life for cancer survivors. Impairment profiles have been heterogeneous across studies, necessitating the study of these effects across different cohorts. The purpose of this preliminary study is to compare the memory profiles of Northeast Ontario breast and CNS cancer patients, as there is no literature which exists for profiling CRCI within this largely rural region. METHODS Sixty-three outpatients with breast cancer (n = 32) or CNS tumors (n = 30) at the Northeast Cancer Centre in Sudbury, Canada, were administered a neuropsychological test battery as part of their clinical examination. Domains measured within this study included attention and concentration, processing speed, motor function, language skills, verbal and visual memory, and executive functioning. RESULTS Participants with brain tumors scored poorer on most neuropsychological measures than participants with breast cancer. Initial verbal memory for individuals with breast cancer was lower than delayed recall and recognition trials. Trial 1 performance for this group was also negatively correlated with self-reported anxiety scores. CONCLUSIONS Consistent with the literature, participants with breast cancer obtained higher scores on most test measures than participants with CNC tumors. Breast cancer participants had lower verbal memory scores on initial trials compared to delayed recall, potentially due to relationships with anxiety and attention. Further research into this cohort will strive to gain greater understanding of the patterns of deficits experienced and how these may inform individuals with cancer in other regions.
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Affiliation(s)
- Matias Mariani
- Supportive Care Oncology Research Unit, Supportive Care Unit, Northeast Cancer Centre, Health Sciences North, 41 Ramsey Lake Road, Sudbury, ON, P3E 5J1, Canada. .,Mariani and Associates, 208 Caswell Dr., Sudbury, ON, P3E 2N8, Canada.
| | - Mark William Glister Collins
- Supportive Care Oncology Research Unit, Supportive Care Unit, Northeast Cancer Centre, Health Sciences North, 41 Ramsey Lake Road, Sudbury, ON, P3E 5J1, Canada
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28
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Abstract
As the population of cancer survivors has grown into the millions, there has been increasing emphasis on understanding how the late effects of treatment affect survivors' ability to return to work/school, their capacity to function and live independently, and their overall quality of life. This review focuses on cognitive change associated with cancer and cancer treatments. Research in this area has progressed from a pharmacotoxicology perspective to a view of the cognitive change as a complex interaction of aspects of the treatment, vulnerability factors that increase risk for posttreatment cognitive decline, cancer biology, and the biology of aging. Methodological advances include the development of (a) measurement approaches that assess more fine-grained subcomponents of cognition based on cognitive neuroscience and (b) advanced statistical approaches. Conceptual issues that arise from this multidimensional perspective are described in relation to future directions, understanding of mechanisms, and development of innovative interventions.
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Affiliation(s)
- Tim A Ahles
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA; ,
| | - James C Root
- Neurocognitive Research Lab, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10022, USA; ,
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29
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Lieberman NAP, Vitanza NA, Crane CA. Immunotherapy for brain tumors: understanding early successes and limitations. Expert Rev Neurother 2018; 18:251-259. [DOI: 10.1080/14737175.2018.1425617] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Nicole A. P. Lieberman
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, WA, USA
| | - Nicholas A. Vitanza
- Division of Hematology/Oncology, Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Courtney A. Crane
- Ben Towne Center for Childhood Cancer Research, Seattle Children’s Research Institute, Seattle, WA, USA
- Department of Neurological Surgery, University of Washington School of Medicine, Seattle, WA, USA
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31
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Association between psychological distress, subjective cognitive complaints and objective neuropsychological functioning in brain tumor patients. Clin Neurol Neurosurg 2017; 163:18-23. [PMID: 29035741 DOI: 10.1016/j.clineuro.2017.10.007] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/23/2017] [Accepted: 10/09/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Psychological distress and cognitive impairment are common complications in patients with brain tumors that are associated with poor quality of life and worse prognosis. This pilot study aimed to evaluate the associations between psychological distress, subjective cognitive complaints and baseline neuropsychological performance of brain tumor patients before neurosurgery. PATIENTS AND METHODS Sixty-two patients with various brain tumors referred for routine neuropsychological assessment 2-3days before neurosurgery participated in the study. Short neuropsychological assessment battery was used to evaluate attention and executive functions, memory and verbal fluency. Presence of cognitive complaints was evaluated during neuropsychological interview using standardized symptoms checklist. Level of psychological distress was assessed using the Hospital Anxiety and Depression Scale. RESULTS Various attention and executive function problems were reported by 13-58% patients; memory problems by 8-63%; language problems by 10-58% of patients. 36-57% of patients scored below 5th percentile on objective memory measures; 32-45% on attention measures and 11-27% on verbal fluency. However, correlation between objective neuropsychological findings and subjective cognitive complaints was weak, ranging from 0.0 to 0.3. 45% of patients met criteria for increased psychological distress. Psychological distress was associated with subjective cognitive complaints but failed to predict objective neuropsychological findings. Brain tumor histological diagnosis, side and location were not related to neuropsychological functioning. CONCLUSION Cognitive impairment and psychological distress are highly prevalent in BT patients before neurosurgery. Although depression and distress may adversely impact quality of life and prognosis of BT patients, our current findings do not confirm that distress has strong negative impact on objective preoperative cognitive functioning. However, it is related to worse subjective evaluation of one's cognitive abilities. Therefore, objective neuropsychological assessment of cognitive functions is highly recommended despite concern.
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32
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Lang S, Cadeaux M, Opoku-Darko M, Gaxiola-Valdez I, Partlo LA, Goodyear BG, Federico P, Kelly J. Assessment of Cognitive, Emotional, and Motor Domains in Patients with Diffuse Gliomas Using the National Institutes of Health Toolbox Battery. World Neurosurg 2017; 99:448-456. [DOI: 10.1016/j.wneu.2016.12.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 12/31/2022]
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33
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Neurocognitive impact of cranial radiation in adults with cancer: an update of recent findings. Curr Opin Support Palliat Care 2017; 11:32-37. [DOI: 10.1097/spc.0000000000000255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Yang N, Gao X, Qu X, Zhang R, Tong F, Cai Q, Dong J, Hu Y, Wu G, Dong X. PIDD Mediates Radiation-Induced Microglia Activation. Radiat Res 2016; 186:345-359. [PMID: 27643878 DOI: 10.1667/rr14374.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Radiation-induced brain injury (RIBI) is the most common adverse effect that occurs after cranial radiation therapy (CRT). We have previously reported that CRT-induced release of pro-inflammatory cytokines in brain tissues and inhibition of neurogenesis in the hippocampus might be caused by microglial activation and may play an important role in RIBI. In this study we examined the role of p53-induced protein with a death domain (PIDD) in radiation-induced activation of BV-2 cells. BV-2 cells were transfected with antisense oligonucleotide control mRNA or antisense oligonucleotide-targeted PIDD mRNA and were sham or 16 Gy irradiated. The state of microglia and expression of pro-inflammatory cytokines were detected using real-time polymerase chain reaction, Western blotting, immunofluorescence and flow cytometry. Findings from this study suggest that silencing PIDD expression could inhibit microglial activation by downregulating the PIDD-C/NF-κβ transcription pathway. PIDD acts as a critical switcher between the NF-κβ transcription pathway and radiation-induced apoptosis. Given these findings, this study offers a potential novel approach to further combination treatment of RIBI.
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Affiliation(s)
- Nong Yang
- a Lung Cancer and Gastroenterology Department, Hunan Cancer Hospital, Affiliated Tumor Hospital of Xiangya Medical School of Central South University, Changsha, 410006, China; and
| | | | | | | | | | | | | | - Yu Hu
- d Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
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35
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Abstract
Radiotherapy (RT) has proven to be an effective therapeutic tool in treatment of a wide variety of brain tumors; however, it has a negative impact on quality of life and neurocognitive function. Cognitive dysfunction associated with both the disease and adverse effects of RT is one of the most concerning complication among long-term survivors. The effects of RT to brain can be divided into acute, early delayed, and late delayed. It is, however, the late delayed effects of RT that lead to severe neurological consequences such as minor-to-severe cognitive deficits due to irreversible focal or diffuse necrosis of brain parenchyma. In this review, we discuss current and emerging data regarding the relationship between RT and neurocognitive outcomes, and therapeutic strategies to prevent/treat postradiation neurocognitive deficits.
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36
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Piil K, Jakobsen J, Juhler M, Jarden M. The feasibility of a brain tumour website. Eur J Oncol Nurs 2015; 19:686-93. [DOI: 10.1016/j.ejon.2015.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 04/29/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
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37
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Bergo E, Lombardi G, Guglieri I, Capovilla E, Pambuku A, Zagone V. Neurocognitive functions and health-related quality of life in glioblastoma patients: a concise review of the literature. Eur J Cancer Care (Engl) 2015; 28:e12410. [PMID: 26531122 DOI: 10.1111/ecc.12410] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2015] [Indexed: 11/29/2022]
Abstract
The maintenance of quality of life in patients with high-grade glioma is an important endpoint during treatment, particularly in those with glioblastoma multiforme, given its dismal prognosis; thus, the primary aims of treatments are to reduce morbidity, restore or preserve neurological functions, and the capacity to perform daily activities. This review aims to summarise what is currently known about neurocognitive outcome and quality of life in patients with high-grade glioma, particularly in glioblastoma patients. We considered all the variables that can influence neurocognitive functions, the perception of quality of life and their role as predictors for treatment outcomes.
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Affiliation(s)
- E Bergo
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Veneto Institute of Oncology IOV- IRCCS, Padua.,Psycho-Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padua, Italy
| | - G Lombardi
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Veneto Institute of Oncology IOV- IRCCS, Padua
| | - I Guglieri
- Psycho-Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padua, Italy
| | - E Capovilla
- Psycho-Oncology Unit, Veneto Institute of Oncology IOV- IRCCS, Padua, Italy
| | - A Pambuku
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Veneto Institute of Oncology IOV- IRCCS, Padua
| | - V Zagone
- Department of Clinical and Experimental Oncology, Medical Oncology 1 Unit, Veneto Institute of Oncology IOV- IRCCS, Padua
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38
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Sacks-Zimmerman A, Duggal D, Liberta T. Cognitive Remediation Therapy for Brain Tumor Survivors with Cognitive Deficits. Cureus 2015; 7:e350. [PMID: 26623205 PMCID: PMC4641743 DOI: 10.7759/cureus.350] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cognitive deficits have been widely observed in patients with primary brain tumors consequent to diagnosis and treatment. Given the early onset and the relatively long survival rate of patients, it seems pertinent to study and refine the techniques used to treat these deficits. The purpose of this article is to discuss cognitive deficits that follow neurosurgical treatment for low-grade gliomas as well as to outline a neuropsychological intervention to treat these deficits, specifically working memory and attention. Cognitive remediation therapy is a neuropsychological intervention that aims to enhance attention, working memory, and executive functioning, thereby diminishing the impact of these deficits on daily functioning. Computerized cognitive remediation training programs facilitate access to treatment through providing online participation. The authors include preliminary results of three participants who have completed the computerized training program as part of an ongoing study that is investigating the efficacy of this program in patients who have undergone treatment for low-grade gliomas. The results so far suggest some improvement in working memory and attention from baseline scores. It is the hope of the present authors to highlight the importance of this treatment in the continuity of care of brain tumor survivors.
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39
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Defrancesco M, Sperner-Unterweger B. [Diagnosis and therapy of cognitive deficits in oncology patients]. DER NERVENARZT 2015; 86:282-290. [PMID: 25676924 DOI: 10.1007/s00115-014-4155-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Improvements in the diagnostics and therapy of almost all types of cancer have extended the survival rates and average life expectancies of oncology patients. As a result the assessment of cognitive deficits is becoming much more important not only in cancer diagnostics but also in the disease-free period following treatment. Various cognitive deficits can occur in patients with intracranial as well as extracranial malignancies. These deficits can be caused by tumor or treatment-related factors. Previous studies have shown that cognitive deficits may negatively influence the quality of life, therapy adherence, prognosis and mortality of patients. Currently, standardized specially designed cognitive tests for oncology patients are lacking; nevertheless, neurocognitive assessment should become an integral element in the diagnostic procedure as well as in the therapeutic process of these patients. An increasing number of studies are currently evaluating pharmacological and non-pharmacological strategies to treat or prevent cognitive deficits; however, recommendations for daily clinical use are still lacking.
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Affiliation(s)
- M Defrancesco
- Universitätsklinik für Allgemeine und Sozialpsychiatrie, Department für Psychiatrie und Psychotherapie, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich,
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40
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Dong X, Luo M, Huang G, Zhang J, Tong F, Cheng Y, Cai Q, Dong J, Wu G, Cheng J. Relationship between irradiation-induced neuro-inflammatory environments and impaired cognitive function in the developing brain of mice. Int J Radiat Biol 2015; 91:224-39. [PMID: 25426696 DOI: 10.3109/09553002.2014.988895] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Radiation-induced brain injury (RIBI) is the most common side-effect after cranial radiation therapy (CRT). In the present study, the RIBI mice model was established and the changes in the expression of tumor necrosis factor alpha (TNF-α) and interleukin-1beta (IL-1β) mRNA, and the related signal pathways in the hippocampus of this model were investigated. MATERIALS AND METHODS 10 Gy CRT or sham-irradiation was given to the three-week old mice. The water maze test was used to test the RIBI model in mice. The expression of pro-inflammatory cytokines was detected by real-time polymerase chain reaction (PCR) in vivo. The changes of microglial activation and neurogensis in the hippocampus were analyzed by immunofluorescence and immunohistochemistry. The cytoplasm to nuclei translocation of Nuclear factor kappa B (NF-κB), and the protein expressions of IkappaB-alpha (IκB-α), NF-κB essential modulator (NEMO), p53-induced protein with a death domain (PIDD), TNF-α and IL-1β were examined by Western blotting. A RIBI model was established by Morris water maze test 6 weeks after 10 Gy CRT in three-week old C57BL/6J mice. RESULTS The mRNA and protein expression levels of TNF-α and IL-1β reached the peak during the early phase after CRT. Increases in cytokine levels also were observed after irradiation of mouse BV-2 microglial cells. Neurogensis was significantly inhibited in the hippocampus with an increase of terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) positive cells. The total number of microglia was decreased after CRT, but microglial activation was significantly increased. Western blotting revealed, in the RIBI mice, the expression of IκB-α was down-regulated, accompanied by the up-regulated expression of NEMO and regulated auto-proteolysis of PIDD. Also the NF-κB pathway activation was observed in BV-2 cells after irradiation. CONCLUSIONS CRT-induced pro-inflammatory cytokines release in the brain tissues and inhibition of neurogenesis in the hippocampus might be contributed by the microglial activation and play an important role in RIBI.
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Affiliation(s)
- Xiaorong Dong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology , Wuhan , P. R. China
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41
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Luherne-du Boullay V, Plaza M, Perrault A, Capelle L, Chaby L. Atypical crossmodal emotional integration in patients with gliomas. Brain Cogn 2014; 92C:92-100. [DOI: 10.1016/j.bandc.2014.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 12/13/2022]
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Correa DD, Satagopan J, Baser RE, Cheung K, Richards E, Lin M, Karimi S, Lyo J, DeAngelis LM, Orlow I. APOE polymorphisms and cognitive functions in patients with brain tumors. Neurology 2014; 83:320-7. [PMID: 24944262 DOI: 10.1212/wnl.0000000000000617] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The goal of this study was to assess whether the APOE ε4 allele and other APOE single nucleotide polymorphisms (SNPs) influence neuropsychological and neuroimaging outcomes in patients with brain tumors. METHODS Two hundred eleven patients with brain tumors participated in the study. All patients completed standardized neuropsychological tests and provided a blood sample for APOE genotyping. Ratings of white matter abnormalities were performed on MRI scans. Patients were classified into 2 groups based on the presence (n = 50) or absence (n = 161) of at least one APOE ε4 allele. Additional APOE SNPs were genotyped in a subset of 150 patients. RESULTS Patients with at least one APOE ε4 allele had significantly lower scores in verbal learning and delayed recall, and marginally significant lower scores in executive function, in comparison to noncarriers of an ε4 allele. Patients with at least one ε4 allele and history of cigarette smoking had significantly higher scores in working memory and verbal learning than ε4 carriers who never smoked. Nine additional APOE SNPs were significantly associated with attention and executive and memory abilities. There were no significant differences between ε4 carriers and noncarriers on the extent of white matter abnormalities on MRI. CONCLUSIONS The findings suggest that patients with brain tumors who are carriers of the APOE ε4 allele may have increased vulnerability to developing memory and executive dysfunction, and that additional SNPs in the APOE gene may be associated with cognitive outcome.
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Affiliation(s)
- Denise D Correa
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY.
| | - Jaya Satagopan
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Raymond E Baser
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Kenneth Cheung
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Elizabeth Richards
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Michael Lin
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Sasan Karimi
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - John Lyo
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Lisa M DeAngelis
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
| | - Irene Orlow
- From the Departments of Neurology (D.D.C., E.R., L.M.D.), Epidemiology and Biostatistics (J.S., R.E.B., K.C., I.O.), and Radiology (S.K., J.L.), Memorial Sloan-Kettering Cancer Center, New York; and Department of Neurology (D.D.C., M.L., L.M.D.), Weill Cornell Medical College, New York, NY
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Ali AN, Ogunleye T, Hardy CW, Shu HK, Curran WJ, Crocker IR. Improved hippocampal dose with reduced margin radiotherapy for glioblastoma multiforme. Radiat Oncol 2014; 9:20. [PMID: 24411020 PMCID: PMC3904484 DOI: 10.1186/1748-717x-9-20] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/26/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND To dosimetrically evaluate the effect of reduced margin radiotherapy on hippocampal dose for glioblastoma multiforme (GBM) patients. METHODS GBM patients enrolled on the Radiation Therapy Oncology Group (RTOG) 0825 trial at our institution were identified. Standard RTOG 0825 expansions were 2 cm + 3-5 mm from the gross tumor volume (GTV) to the clinical tumor volume (CTV) and from the CTV to the planning tumor volume (PTV), respectively. These same patients also had reduced margin tumor volumes generated with 8 mm (GTV to CTV) + 3 mm (CTV to PTV) expansions. Individual plans were created for both standard and reduced margin structures. The dose-volume histograms were statistically compared with a paired, two-tailed Student's t-test with a significance level of p < 0.05. RESULTS A total of 16 patients were enrolled on RTOG 0825. The reduced margins resulted in statistically significant reductions in hippocampal dose at all evaluated endpoints. The hippocampal Dmax was reduced from a mean of 61.4 Gy to 56.1 Gy (8.7%), D40% was reduced from 49.9 Gy to 36.5 Gy (26.9%), D60% was reduced from 32.7 Gy to 18.7 Gy (42.9%) and the D80% was reduced from 27.3 Gy to 15.3 Gy (44%). CONCLUSIONS The use of reduced margin PTV expansions in the treatment of GBM patients results in significant reductions in hippocampal dose. Though the exact clinical benefit of this reduction is currently unclear, this study does provide support for a future prospective trial evaluating the neurocognitive benefits of reduced margin tumor volumes in the treatment of GBM patients.
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Affiliation(s)
- Arif N Ali
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
- Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
| | - Tomi Ogunleye
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
- Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
| | - Claire W Hardy
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
- Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
| | - Hui-Kuo Shu
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
- Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
| | - Walter J Curran
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
- Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
| | - Ian R Crocker
- Department of Radiation Oncology, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
- Winship Cancer Institute, Emory University, 1365 Clifton Rd. NE, Atlanta, GA 30322, USA
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Abstract
Executive functions refer to a constellation of higher-level cognitive abilities that enable goal-oriented behavior. The NIH EXAMINER battery was designed to assess executive functions comprehensively and efficiently. Performance can be summarized by a single score, the "Executive Composite," which combines measures of inhibition, set-shifting, fluency, and working memory. We evaluated the ecological validity of the Executive Composite in a sample of 225 mixed neurological patients and controls using the Frontal Systems Behavior Scale (FrSBe), an informant-based measure of real-world executive behavior. In addition, we investigated the neuroanatomical correlates of the Executive Composite using voxel-based morphometry in a sample of 37 participants diagnosed with dementia, mild cognitive impairment, or as neurologically healthy. The Executive Composite accounted for 28% of the variance in Frontal Systems Behavior Scale scores beyond age. Even after including two widely used executive function tests (Trails B and Stroop) as covariates, the Executive Composite remained a significant predictor of real-world behavior. Anatomically, poorer scores on the Executive Composite were associated with smaller right and left dorsolateral prefrontal volumes, brain regions critical for good executive control. Taken together, these results suggest that the Executive Composite measures important aspects of executive function not captured by standard measures and reflects the integrity of frontal systems.
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McDuff SGR, Taich ZJ, Lawson JD, Sanghvi P, Wong ET, Barker FG, Hochberg FH, Loeffler JS, Warnke PC, Murphy KT, Mundt AJ, Carter BS, McDonald CR, Chen CC. Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases. J Neurol Neurosurg Psychiatry 2013; 84:1384-91. [PMID: 23715918 DOI: 10.1136/jnnp-2013-305166] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The treatment of metastatic brain lesions remains a central challenge in oncology. Because most chemotherapeutic agents do not effectively cross the blood-brain barrier, it is widely accepted that radiation remains the primary modality of treatment. The mode by which radiation should be delivered has, however, become a source of intense controversy in recent years. The controversy involves whether patients with a limited number of brain metastases should undergo whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) delivered only to the radiographically visible tumours. Survival is comparable for patients treated with either modality. Instead, the controversy involves the neurocognitive function (NCF) of radiating cerebrum that appeared radiographically normal relative to effects of the growth from micro-metastatic foci. A fundamental question in this debate involves quantifying the effect of WBRT in patients with cerebral metastasis. To disentangle the effects of WBRT on neurocognition from the effects inherent to the underlying disease, we analysed the results from randomised controlled studies of prophylactic cranial irradiation in oncology patients as well as studies where patients with limited cerebral metastasis were randomised to SRS versus SRS+WBRT. In aggregate, these results suggest deleterious effects of WBRT in select neurocognitive domains. However, there are insufficient data to resolve the controversy of upfront WBRT versus SRS in the management of patients with limited cerebral metastases.
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Affiliation(s)
- Susan G R McDuff
- Center for Theoretical and Applied Neuro-Oncology, University of California, , La Jolla, California, USA
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Collins C, Gehrke A, Feuerstein M. Cognitive Tasks Challenging Brain Tumor Survivors at Work. J Occup Environ Med 2013; 55:1426-30. [DOI: 10.1097/jom.0b013e3182a64206] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Gehrke AK, Baisley MC, Sonck ALB, Wronski SL, Feuerstein M. Neurocognitive deficits following primary brain tumor treatment: systematic review of a decade of comparative studies. J Neurooncol 2013; 115:135-42. [DOI: 10.1007/s11060-013-1215-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 07/28/2013] [Indexed: 12/20/2022]
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Oehler J, Brachwitz T, Wendt TG, Banz N, Walther M, Wiezorek T. Neural stem cell sparing by linac based intensity modulated stereotactic radiotherapy in intracranial tumors. Radiat Oncol 2013; 8:187. [PMID: 23883368 PMCID: PMC3729420 DOI: 10.1186/1748-717x-8-187] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 07/21/2013] [Indexed: 11/16/2022] Open
Abstract
Background Neurocognitive decline observed after radiotherapy (RT) for brain tumors in long time survivors is attributed to radiation exposure of the hippocampus and the subventricular zone (SVZ). The potential of sparing capabilities for both structures by optimized intensity modulated stereotactic radiotherapy (IMSRT) is investigated. Methods Brain tumors were irradiated by stereotactic 3D conformal RT or IMSRT using m3 collimator optimized for PTV and for sparing of the conventional OARs (lens, retina, optic nerve, chiasm, cochlea, brain stem and the medulla oblongata). Retrospectively both hippocampi and SVZ were added to the list of OAR and their dose volume histograms were compared to those from two newly generated IMSRT plans using 7 or 14 beamlets (IMSRT-7, IMSRT-14) dedicated for optimized additional sparing of these structures. Conventional OAR constraints were kept constant. Impact of plan complexity and planning target volume (PTV) topography on sparing of both hippocampi and SVZ, conformity index (CI), the homogeneity index (HI) and quality of coverage (QoC) were analyzed. Limits of agreement were used to compare sparing of stem cell niches with either IMSRT-7 or IMSRT-14. The influence of treatment technique related to the topography ratio between PTV and OARs, realized in group A-D, was assessed by a mixed model. Results In 47 patients CI (p ≤ 0.003) and HI (p < 0.001) improved by IMSRT-7, IMSRT-14, QoC remained stable (p ≥ 0.50) indicating no compromise in radiotherapy. 90% of normal brain was exposed to a significantly higher dose using IMSRT. IMSRT-7 plans resulted in significantly lower biologically effective doses at all four neural stem cell structures, while contralateral neural stem cells are better spared compared to ipsilateral. A further increase of the number of beamlets (IMSRT-14) did not improve sparing significantly, so IMSRT-7 and IMSRT-14 can be used interchangeable. Patients with tumors contacting neither the subventricular zone nor the cortex benefit most from IMSRT (p < 0.001). Conclusion The feasibility of neural stem cell niches sparing with sophisticated linac based inverse IMSRT with 7 beamlets in an unselected cohort of intracranial tumors in relation to topographic situation has been demonstrated. Clinical relevance testing neurotoxicity remains to be demonstrated.
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Affiliation(s)
- Julia Oehler
- Department of Radiation Oncology, Jena University Hospital, Friedrich-Schiller-University Jena, Bachstrasse 18, Jena D-07743, Germany
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Merriman JD, Aouizerat BE, Langford DJ, Cooper BA, Baggott CR, Cataldo JK, Dhruva A, Dunn L, West C, Paul SM, Ritchie CS, Swift PS, Miaskowski C. Preliminary evidence of an association between an interleukin 6 promoter polymorphism and self-reported attentional function in oncology patients and their family caregivers. Biol Res Nurs 2013; 16:152-9. [PMID: 23482714 DOI: 10.1177/1099800413479441] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subgroups of individuals may be at greater risk of cytokine-induced changes in attentional function. The purposes of this study were to identify subgroups of individuals with distinct trajectories of attentional function and evaluate for phenotypic and genotypic (i.e., cytokine gene polymorphisms) differences among these subgroups. Self-reported attentional function was evaluated in 252 participants (167 oncology patients and 85 family caregivers) using the Attentional Function Index before radiation therapy and at six additional assessments over 6 months. Three latent classes of attentional function were identified using growth mixture modeling: moderate (36.5%), moderate-to-high (48.0%), and high (15.5%) attentional function. Participants in the moderate class were significantly younger, with more comorbidities and lower functional status, than those in the other two classes. However, only functional status remained significant in multivariable models. Included in the genetic association analyses were 92 single nucleotide polymorphisms (SNPs) among 15 candidate genes. Additive, dominant, and recessive genetic models were assessed for each SNP. Controlling for functional status, only Interleukin 6 (IL6) rs1800795 remained a significant genotypic predictor of class membership in multivariable models. Each additional copy of the rare "G" allele was associated with a 4-fold increase in the odds of belonging to the lower attentional function class (95% confidence interval: [1.78, 8.92]; p = .001). Findings provide preliminary evidence of subgroups of individuals with distinct trajectories of attentional function and of a genetic association with an IL6 promoter polymorphism.
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Affiliation(s)
- John D Merriman
- 1School of Nursing, University of California, San Francisco, CA, USA
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Plaza M, Capelle L, Maigret G, Chaby L. Strengths and weaknesses of multimodal processing in a group of adults with gliomas. Neurocase 2013; 19:302-12. [PMID: 22554225 DOI: 10.1080/13554794.2012.667128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The present study aimed to analyze the multimodal skills that would be spared, altered, or impaired by gliomas that slowly infiltrate various and diversely localized areas in the cerebral hemispheres. Ten patients and 60 healthy controls were evaluated using four multimodal processing paradigms across 11 tasks. Our objectives were as follows: (a) to describe the strengths and weaknesses of the glioma patients' multimodal processing performance after accounting for task specificity and their individual performances compared to those of the control group; (b) to determine the correlation between lesion localization and impairments; and (c) to identify the tasks that were most sensitive to tumor infiltration and plasticity limits. Our results show that patients as a whole were efficient at most tasks; however, the patients exhibited difficulties in the productive picture-naming task, the receptive verbal judgment task, and the visual/graphic portion of the dual-attention task. The individual case reports show that the difficulties were distributed across the patients and did not correlate with lesion localization and tumor type.
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