Neurobehavioral sequelae of cranial irradiation in adults: a review of radiation-induced encephalopathy.

Abstract

It is likely that the true incidence of treatment-related side effects of cranial irradiation in adults who survive more than 6 months without brain tumor growth or recurrence has been significantly underestimated. Research designs that include formal neuropsychologic assessment in conjunction with other neurodiagnostic tests can provide more comprehensive evaluation of long-term neurobehavioral outcomes.

Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study

“…7,8 Apart from potential favourable survival effects, radiotherapy itself could negatively affect the patient's health-related quality of life through irreversible late-delayed brain damage induced by irradiation, ultimately resulting in cognitive deficits and dementia. 9,10 In long-term survivors of brain metastases from systemic cancer, and in patients with primary lymphoma of the central nervous system, treatment with whole-brain radiotherapy can lead to radiation-induced encephalopathy. 11,12 Partly because of these side-effects, standard treatment of glioma patients is based on focal radiotherapy rather than on whole-brain radiotherapy.…”

“…9 The incidence of late-delayed encephalopathy in these patients is steadily increasing, not only because of increased survival but also because of improved detection (neuroimaging and extensive cognitive function testing) and raised awareness among physicians and patients. 9 With 5-year and 10-year progression-free rates of 50% and 12%, respectively, for supratentorial low-grade astrocytomas, low-grade oligodendrogliomas, and mixed gliomas, 13 and a median better survival of 16·7 years for the latter two groups, 14 patients with low-grade gliomas can survive in a stable state for several years after diagnosis. The long-term cognitive and psychosocial sequelae of the disease and its treatment in these longterm survivors are especially salient.…”

Neuropsychological dysfunction associated with cancer and cancer therapies: a conceptual review of an emerging target

“…The adverse effects of radiation to the brain, both as primary CNS therapy and prophylactic treatment, have been previously reviewed in detail (Crossen et al, 1994;Keime-Guibert et al, 1998). The development of neurologic and/or neuropsychological dysfunction is often the greatest dose-limiting factor of radiotherapy (XRT).…”

“…mental flexibility), and often bilateral decline in motor function (e.g. fine motor dexterity) (Crossen et al, 1994;Gregor et al, 1996;Meyers et al, 2000a).…”

“…Radiation to the brain is rarely administered without systemic chemotherapy for the primary disease, and it is often not possible to separate the adverse effects of radiation from chemotherapy. The toxicity of radiation is likely synergistic with concurrent chemotherapy (Crossen et al, 1994). Thus, discussion of treatment effects will assume that the toxicity is caused primarily by cranial irradiation, although the possible synergistic toxicity of multimodality therapy is yet to be fully delineated.…”