Assessment of neurocognitive function in illiterate patients of high-grade glioma treated with chemoradiation.

Abstract

e13543 Background: Although the role of chemo-radiation (CRT) in gliomas has been studied extensively, its effects on neurocognitive function (NCF) remain elusive. Assessment of NCF in illiterate patients is a challenge. Methods: Illiterate adults with histopathologically proven high grade gliomas planned for CRT following maximal safe resection were included. Temozolomide based CRT using standard protocols was planned. Neurocognitive function was assessed using the Addenbrooke’s Cognitive Examination (ACE-III) questionnaire prior to the start of CRT and at 3 and 6 months post RT. The subventricular zones (SVZ) and hippocampus were contoured using standard guidelines. The NCF scores were compared using the paired t test. Results: 32 patients were recruited. The median age was 40 years. M:F ratio was 1:1.16. IMRT to a dose 60 Gy with concurrent and adjuvant temozolomide was planned. Overall there was no significant difference in scores at 3 months and a significant decline in visuospatial scores at 6 months (p < 0.001). Mean doses to the ipsilateral and contralateral SVZ were 49.5 Gy and 35 Gy respectively. Based on mean ipsilateral SVZ dose, patients were divided into: Group I < 50 Gy (n = 18), group II ≥ 50 Gy (n = 14). At 3 months there was significant improvement in scores in Group I whereas a decline in scores in Group II. At 3 months, memory (18.73 vs 21.93; p = 0.021) and fluency (10.20 vs 11.67; p = 0.042) showed improvement in group I patients. In group II there was decline in visuospatial scores (14.41 vs 13.71; p = 0.016) at 3 months. At six months, there was improvement in memory (17.94 vs 22.94; p = 0.002), attention (14.78 vs 16.39; p = 0.031), fluency (10.11 vs 11.67; p = 0.018) and total ACE scores (80.83 vs 89.94; p = 0.008) in group 1 patients and a significant decline in visuospatial function, attention, memory and language scores in group II patients. Higher contralateral SVZ doses (> 35 Gy) correlated with a significant decline in visuospatial scores at 3 and 6 months. Lower mean dose to ipsilateral hippocampus (< 40 Gy) correlated significantly with improved memory scores. Doses to contralateral hippocampus did not correlate with scores. Conclusions: The Addenbrooke’s Cognitive Examination (ACE-III) questionnaire can be used to assess NCF in patients with gliomas including illiterate patients. Lower mean doses to the ipsilateral and contralateral SVZ and hippocampus resulted in improvement/preservation of memory, attention and fluency whereas higher doses were associated with a decline in scores.