Cognitive outcomes after multimodal treatment in adult glioma patients: A meta-analysis

Roeck, Laurien De; Gillebert, R Céline; Aert, Robbie C. M. van; Vanmeenen, Amber; Klein, Martin; Taphoorn, Martin J.B.; Gehring, Karin; Lambrecht, Maarten; Sleurs, Charlotte

doi:10.1093/neuonc/noad045

Cited by 12 publications

(4 citation statements)

References 77 publications

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“…As demonstrated in recent randomized trials and the present study, glioma patients are at high risk of developing cognitive decline during their course of disease. 3 Although the relationship between brain damage and neurological function is generally well established for the eloquent primary cortical areas and their associated fiber tracts, 35 the underlying causes of cognitive deterioration in brain tumor patients remain poorly understood. 36–38 Nevertheless, initial studies in glioma patients suggested that evaluating brain networks may help further elucidate the cognitive decline of various domains.…”

Section: Discussionmentioning

confidence: 99%

“… 1 The prognosis of patients with gliomas mainly depends on molecular and histomorphologic tumor features that determine the growth rate and pattern of invasion into the normal brain tissue. 2 Apart from a reduced survival time, glioma patients frequently experience disturbances of cognitive function 3 that are potentially related to the structural damage imposed on the brain by the tumor itself or therapeutic interventions. Compared to other neurological disorders, such as stroke, multiple sclerosis, or dementia, the pattern of brain lesions in glioma patients is more heterogeneous, as it may comprise brain infiltration by residual or recurrent tumor growth, disruption of the blood-brain barrier, neurosurgical resection of cortical or subcortical brain tissue, or radiation- or chemotherapy-induced damage of white matter.…”

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confidence: 99%

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Structural connectome-based predictive modeling of cognitive deficits in treated glioma patients

Friedrich,

Filss,

Lohmann

et al. 2023

Neuro-Oncology Advances

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Background In glioma patients, tumor growth and subsequent treatments are associated with various types of brain lesions. We hypothesized that cognitive functioning in these patients critically depends on the maintained structural connectivity of multiple brain networks. Methods The study included 121 glioma patients (median age, 52 years; median ECOG score 1; CNS-WHO grade 3 or 4) after multimodal therapy. Cognitive performance was assessed by ten tests in five cognitive domains at a median of 14 months after treatment initiation. Hybrid amino acid PET/MRI using the tracer O-(2-[18F]fluoroethyl)-L-tyrosine, a network-based cortical parcellation, and advanced tractography were used to generate whole-brain fiber count-weighted connectivity matrices. The matrices were applied to a cross-validated machine-learning model to identify predictive fiber connections (edges), critical cortical regions (nodes), and the networks underlying cognitive performance. Results Compared to healthy controls (n=121), patients' cognitive scores were significantly lower in nine cognitive tests. The models predicted the scores of 7/10 tests (median correlation coefficient, 0.47; range, 0.39-0.57) from 0.6-5.4% of the matrix entries; 84% of the predictive edges were between nodes of different networks. Critically involved cortical regions (≥10 adjacent edges) included predominantly left-sided nodes of the visual, somatomotor, dorsal/ventral attention, and default mode networks. Highly critical nodes (≥15 edges) included the default-mode network’s left temporal and bilateral posterior cingulate cortex. Conclusions These results suggest that the cognitive performance of pretreated glioma patients is strongly related to structural connectivity between multiple brain networks and depends on the integrity of known network hubs also involved in other neurological disorders.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Structural connectome-based predictive modeling of cognitive deficits in treated glioma patients

Friedrich,

Filss,

Lohmann

et al. 2023

Neuro-Oncology Advances

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“…Neurological deficits impact 44–50% of patients with glioma before surgery ( 52 , 68 ) and are more than three times more frequent in patients with diffuse glioma than in age- and sex-matched people from the general population ( 68 ), with cognitive performance often declining over time ( 69 ). These deficits have been identified as reducing HRQoL, with new-onset deficits associated with a reduction of 0.17 in EQ-5D 3L index values relative to no deficit in diffuse lower-grade glioma ( 46 ).…”

Section: Burdenmentioning

confidence: 99%

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

Pöhlmann,

Weller,

Marcellusi

et al. 2024

Front. Oncol.

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Gliomas are a group of heterogeneous tumors that account for substantial morbidity, mortality, and costs to patients and healthcare systems globally. Survival varies considerably by grade, histology, biomarkers, and genetic alterations such as IDH mutations and MGMT promoter methylation, and treatment, but is poor for some grades and histologies, with many patients with glioblastoma surviving less than a year from diagnosis. The present review provides an introduction to glioma, including its classification, epidemiology, economic and humanistic burden, as well as treatment options. Another focus is on treatment recommendations for IDH-mutant astrocytoma, IDH-mutant oligodendroglioma, and glioblastoma, which were synthesized from recent guidelines. While recommendations are nuanced and reflect the complexity of the disease, maximum safe resection is typically the first step in treatment, followed by radiotherapy and/or chemotherapy using temozolomide or procarbazine, lomustine, and vincristine. Immunotherapies and targeted therapies currently have only a limited role due to disappointing clinical trial results, including in recurrent glioblastoma, for which the nitrosourea lomustine remains the de facto standard of care. The lack of treatment options is compounded by frequently suboptimal clinical practice, in which patients do not receive adequate therapy after resection, including delayed, shortened, or discontinued radiotherapy and chemotherapy courses due to treatment side effects. These unmet needs will require significant efforts to address, including a continued search for novel treatment options, increased awareness of clinical guidelines, improved toxicity management for chemotherapy, and the generation of additional and more robust clinical and health economic evidence.

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“…The overall survival of these patients has considerably evolved over the last two decades, mainly due to the systematization of extensive and early surgical approaches in comparison to "wait and watch" attitudes [27]. However, the natural history of the disease and the cumulative adverse effects of oncological therapies may have a drastic impact on patients' QOL, including individual professional perspectives [28], wellbeing [29], and cognitive functioning, whether at early stages of the disease (and even before the first therapeutical steps [30]) or at the later stages of the oncological management [31]. Consequently, preserving QOL in the long run remains the main objective of the oncological strategies.…”

Section: Functional Goalsmentioning

confidence: 99%

Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies

Duffau

2023

Cancers

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The ability of neural circuits to compensate for damage to the central nervous system is called postlesional plasticity. In diffuse low-grade gliomas (LGGs), a crosstalk between the brain and the tumor activates modulations of plasticity, as well as tumor proliferation and migration, by means of paracrine and electrical intercommunications. Such adaptative mechanisms have a major impact on the benefits and risks of oncological treatments but are still disregarded by current neuro-oncological guidelines. In this review, the authors first aimed to highlight clinical, radiological, and oncological markers that robustly reflect the plasticity potentials and limitations in LGG patients, including the location of the tumor and the degree of critical white matter tract infiltration, the velocity of tumor expansion, and the reactional changes of neuropsychological performances over time. Second, the interactions between the potential/limitations of cerebral plasticity and the efficacy/tolerance of treatment options (i.e., surgery, chemotherapy, and radiotherapy) are reviewed. Finally, a longitudinal and multimodal treatment approach accounting for the evolutive profiles of brain plasticity is proposed. Such an approach integrates personalized predictive models of plasticity potentials with a step-by-step therapeutic decision making and supports onco-functional balanced strategies in patients with LGG, with the ultimate aim of optimizing overall survival and quality of life.

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Cognitive outcomes after multimodal treatment in adult glioma patients: A meta-analysis

Cited by 12 publications

References 77 publications

Structural connectome-based predictive modeling of cognitive deficits in treated glioma patients

Structural connectome-based predictive modeling of cognitive deficits in treated glioma patients

High costs, low quality of life, reduced survival, and room for improving treatment: an analysis of burden and unmet needs in glioma

Brain Plasticity Profiling as a Key Support to Therapeutic Decision-Making in Low-Grade Glioma Oncological Strategies

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