Journal of Clinical Oncology, Vol 13, 2263-2271, Copyright © 1995 by American Society of Clinical Oncology
Biphasic patterns of memory deficits following moderate-dose partial- brain irradiation: neuropsychologic outcome and proposed mechanisms
C Armstrong, J Ruffer, B Corn, K DeVries and J Mollman
Department of Neurology, University of Pennsylvania Medical Center, Philadelphia 19104-4283, USA.
PURPOSE: To identify the longitudinal neurobehavioral characteristics of
the early-delayed and late-delayed effects of partial-brain radiotherapy
for patients with supratentorial brain tumors with favorable histology.
This study improves on previous attempts to identify radiation effects,
because of the inclusion of baseline measures and the use of subjects as
their own controls. PATIENTS AND METHODS: Ten neuropsychologic domains were
measured in 12 patients at baseline (post-surgery and immediately before
initiation of radiotherapy), and followed trimonthly for 1 year. Four to
six patients were examined at 2 and 3 years postbaseline. RESULTS: Patients
were impaired at baseline compared with controls only in visual memory and
sentence recall, but demonstrated significant improvement in visual memory
by 2 years postbaseline. Speed of processing information also showed a
slope of improvement over 2 years. Retrieval from verbal long- term memory
was impaired at 1.5 months postcompletion of radiotherapy, but recovered to
baseline levels by 1 year. At 2 years postbaseline, long-term memory
retrieval demonstrated a decline, but remained unchanged at 3 years.
CONCLUSION: Long-term memory appears to be sensitive to the effects of
radiotherapy. We confirmed our previous findings of a decrement with
rebound during the early-delayed period, and propose that these findings
are consistent with demyelination/remyelination. Decrement was observed
again at 2 years postbaseline, which suggests that memory retrieval may be
the earliest marker of late-delayed effects. These neurocognitive patterns
are consistent with leukoencephalopathy. Confirmation of these observations
will be possible if neuropsychologic testing with the same sensitivity can
be incorporated into national collaborative trials.
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