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Effects of Radiotherapy on Cognitive Function in Patients With Low-Grade Glioma Measured by the Folstein Mini-Mental State Examination

Paul D. Brown, Jan C. Buckner, Judith R. O’Fallon, Nancy L. Iturria, Cerise A. Brown, Brian P. O’Neill, Bernd W. Scheithauer, Robert P. Dinapoli, Robert M. Arusell, Walter J. Curran, Ross Abrams, Edward G. Shaw

From the Mayo Clinic, Rochester, MN; Roger Maris Cancer Center, Fargo, ND; Radiation Therapy Oncology Group (RTOG) Operations Office, Philadelphia, PA; and Wake Forest University, School of Medicine, Winston-Salem, NC.

Address reprint requests to Paul D. Brown, MD, Division of Radiation Oncology, Mayo Clinic, 200 First St SW, Rochester, MN 55905.

Purpose: To assess the neurocognitive effects of cranial radiotherapy on patients with low-grade gliomas, we analyzed cognitive performance data collected in a prospective, intergroup clinical trial.

Methods: Patients included 203 adults with supratentorial low-grade gliomas randomly assigned to a lower dose (50.4 Gy in 28 fractions) or a higher dose (64.8 Gy in 36 fractions) of localized radiotherapy. Folstein Mini-Mental State Examination (MMSE) scores and neurologic function scores (NFS) at baseline and key evaluations were analyzed. Median follow-up was 7.4 years in 101 patients still alive. A change of more than three MMSE points was considered clinically significant.

Results: In patients without tumor progression, significant deterioration from baseline occurred at years 1, 2, and 5 in 8.2%, 4.6%, and 5.3% of patients, respectively. Most patients with an abnormal baseline MMSE score (< 27) experienced significant increases. Baseline variables such as radiation dose, conformal versus conventional radiotherapy, number of radiation fields, age, sex, tumor size, NFS, seizures, and seizure medications did not predict cognitive function changes.

Conclusion: In this population, most low-grade glioma patients maintained a stable neurocognitive status after focal radiotherapy as measured by the MMSE. Patients with an abnormal baseline MMSE were more likely to have an improvement in cognitive abilities than deterioration after receiving radiotherapy. Only a small percentage of patients had cognitive deterioration after radiotherapy. However, more discriminating neurocognitive assessment tools may identify cognitive decline not apparent with the use of the MMSE.

This study was conducted as a collaborative trial of the North Central Cancer Treatment Group and Mayo Clinic and was supported in part by Public Health Service grant nos. CA-25224, CA-37404, CA-15083, and CA-35415, and the Linse Bock Foundation, Rochester, MN.

Presented at the Forty-Third Annual Meeting of the American Society for Therapeutic Radiology and Oncology, San Francisco, CA, November 4–8, 2001, and at the Thirty-Seventh Annual Meeting of the American Society of Clinical Oncology, San Francisco, CA, May 12–15, 2001.

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• The Measurement of Cognitive Functioning in Low-Grade Glioma Patients After Radiotherapy
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