Differential effect of surgery and radiotherapy on neurocognitive functioning and health-related quality of life in WHO grade I meningioma patients

Abstract

Background Potential treatment-related neurotoxicity and the indolent course of the disease mainly feed the controversy concerning the optimal timing of surgery and radiotherapy in meningioma patients. Object To quantify the additional negative effects of conventional radiotherapy compared to surgery alone on neurocognitive functioning and health-related quality of life (HRQOL) in patients with WHO grade I meningiomas. Methods Neurocognitive functioning and HRQOL (SF36, EORTC-BCM20) were assessed in consecutive patients (1999)(2000)(2001)(2002)(2003)(2004)(2005) with WHO grade I meningiomas at least 1 year after surgical treatment in two centers for brain tumor patients. Subsequently, we selected all patients who underwent surgery and conformal external beam fractioned radiotherapy (n = 18) and matched these patients for age, sex, and educational level with the same number of patients who had had surgery only (n = 18), as well as with the same number of healthy controls.Results No significant differences in neurocognitive functioning were found between the two meningioma patient groups; however, even meningioma patients who were treated with surgery only had a significantly lower neurocognitive functioning than healthy controls. Meningioma patients who were treated with surgery and radiotherapy had significantly lower HRQOL scores than meningioma patients who were treated with surgery only, who had HRQOL ratings comparable with healthy controls; these differences, however, disappeared after correction for the duration of disease. Conclusions In contrast with conventional thinking, longterm neurocognitive functioning was significantly impaired in our meningioma patients. Additional radiotherapy following surgery, however, does not have additional deleterious effects on neurocognitive outcome in these patients.

Neurocognition in individuals with incidentally-identified meningioma

“…In that study, there was no association between volume and cognitive functioning [6]. Other studies have reported significant cognitive impairment in meningioma patients either pre- or post- surgery [9, 10], although the average tumor size in both of these studies was much greater than the average size of tumor in our study. Those looking at patients both before and after surgery show mixed findings based on factors such as type of intervention, meningioma size, and patient characteristics [7, 8, 19, 20].…”

“…Studies available on cognitive functioning in meningioma have identified cognitive impairment in subjects who are being followed clinically (e.g., as part of a “wait and scan” approach [6], during pre-surgical evaluation [7, 8], or following surgical intervention [9, 10]). Recently, van Nieuwenhuizen et al studied a sample of 21 individuals with radiologically confirmed WHO Grade I supratentorial meningiomas who were followed with a “wait and scan” approach.…”

The Influence of Adjuvant Radiotherapy in Atypical and Anaplastic Meningiomas: A Series of 88 Patients in a Single Institution

“…However, using modern techniques, sparing of normal tissue is possible, and consequently the risk for neurocognitive impairment is very low. It has been demonstrated that radiotherapy following surgery did not have an increase neurocognitive impairment (56). In a subsequent study, it was suggested that neurocognitive deficits could be partly ascribed to the use of antiepileptic drugs and tumor location rather than radiotherapy (13).…”

A multivariate analysis of prognostic factors for health-related quality of life in patients with surgically managed meningioma

“…5,6 Several groups have investigated the prognostic significance of baseline HQOL parameters and baseline clinical characteristics for clinical outcome. [7][8][9][10] In these studies, a variety of unspecialized HQOL instruments were used to evaluate global HQOL after meningioma resection. However, it is not sufficient to describe the relationship between meningioma and HQOL in global terms.…”