Assessment of neurocognitive functions using ACE-III scale in patients with high-grade glioma receiving adjuvant chemoradiation.

Abstract

e14030 Background: High Grade Gliomas (HGG) are aggressive CNS tumours with poor prognosis despite multimodality management with surgery, radiation and chemotherapy. During the course of the disease and treatment patients experience alterations in neurocognitive functions (NCF) & QOL which is dependent on factors like size, location of tumour, type of surgery, chemo radiotherapy (CTRT) received & disease recurrence. Assessment of change in pattern of NCF is important in optimising treatment and interventions like use of neuroprotectors and in guiding future clinical trials in those directions. Change in NCF significantly affects QOL of patients and their care givers. Most studies on NCF in brain tumours has been conducted on Low Grade Gliomas and various tools have been used in these studies. Addenbrooke Cognitive Examination tool (ACE III) has been used by some in the assessment of NCF in brain tumour. This study aims to assess change in NCF in postoperative HGG patients receiving adjuvant chemoradiation. Methods: 13 newly diagnosed post operative cases of Grade III & IV gliomas were prospectively enrolled in the study. Enrolled patients received adjuvant radiotherapy (RT) (60Gy/30 fractions) using IMRT technique with concurrent Temozolomide (TMZ) 75mg/m2 over 6 weeks. Patients received adjuvant TMZ 150-200 mg/m2 up to six 4-weekly cycles. Pre-treatment Neurocognitive functions were assessed using ACE III scale before start of RT. Post-treatment assessment was done using ACE III at 6 months after completion of RT. The ACE-III scale consists of 5 domains namely Attention (Total Score-18), Memory (TS-26), Fluency (TS-14), Language (TS-26), Visuospatial Abilities (TS-16); the Total Score is given out of 100.The variable are described using mean (SD); Paired t test was used for statistical analysis and baseline data was compared with 6 months’ data. Results: The study group was homogenous with a median age of 42 years. Fronto-parietal region of the brain was most commonly involved. All patients had received concurrent TMZ, completed RT within 6 weeks and received adjuvant TMZ for a period of 6 months. On Comparing baseline to 6 months data; statistically significant improvement was noted in Memory(p-0.049), Language(p-0.031) & the Total Score (p-0.048).There was improvement in total ACE III score in 84% of the patients at 6 months. Conclusions: Significant improvement noted in majority of the postoperative patients at 6 months’ post RT in both total ACE III score and specific domains except a few. Long term follow up needed to assess further change in NCF due to disease or long term treatment related effects.[Table: see text]