Risk Factors for Cognitive Impairment in High-Grade Glioma Patients Treated with Postoperative Radiochemotherapy

Wang, Qiang; Xiao, Fengxia; Qi, Fei; Song, Xiaopeng; Yu, Yang

doi:10.4143/crt.2019.242

Cited by 12 publications

(6 citation statements)

References 30 publications

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“…The majority of patients with grade III or IV gliomas and selected patients with grade II gliomas are scheduled for radiochemotherapy, mainly following neurosurgical resection (4)(5)(6). This situation may produce significant emotional distress for the patients due to fears regarding the treatment procedure, potential side effects, and unsatisfactory treatment outcomes including progression or recurrence of the glioma (7)(8)(9)(10)(17)(18)(19). These fears may lead to sleep problems that can significantly impair the patients' quality of life (11)(12)(13).…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Kopelke

Kjær

Tvilsted

et al. 2021

In Vivo

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Background/Aim: Many patients with malignant gliomas are scheduled for radiochemotherapy, which may cause emotional distress associated with sleep problems. This study aimed to determine the prevalence of such sleep problems in these patients and identify risk factors. Patients and Methods: Fifty-seven patients scheduled for radiochemotherapy for grade II-IV gliomas were retrospectively investigated for pre-treatment sleep problems. Fifteen characteristics were evaluated including temporal relation to age, gender, performance status, comorbidity, (family) history of malignancies, distress score, emotional problems, physical problems, practical problems, involved sites, glioma grade, upfront surgery, and corticosteroids. Results: Nineteen patients stated pre-treatment sleep problems (prevalence=66.7%). Significant associations with sleep problems were found for female gender (p=0.023), presence of emotional problems (p=0.006), and ≥4 physical problems (p<0.001). A trend was found for distress scores ≥5 (p=0.077). Conclusion: The prevalence of sleep problems was high. Risk factors were determined that can be used to identify patients who likely benefit from psychological support.According to the classification of the World Health Organization (WHO), the group of gliomas includes four grades (grades I to IV), of which grade IV tumors (glioblastoma multiforme) are the most aggressive lesions with a 5-year survival rate of about 5% (1-3).Neurosurgical resection should be performed whenever safely possible. In patients with grade III or IV gliomas, resection is generally followed by radiochemotherapy (4-6). This applies also to selected patients with grade II gliomas, mainly after incomplete resection. Assignment to a course of radiochemotherapy may cause significant distress for the patients who may be afraid particularly of the exposure to radiation and potential treatment-related adverse events (7-10). The distress may lead to sleep problems that can significantly impair the patients' quality of life and require psychological support already prior to the start of radiochemotherapy (11)(12)(13). Therefore, the present study investigated the prevalence and potential risk factors of pre-treatment sleep problems in patients with grade II to IV gliomas assigned to radiochemotherapy. These data can contribute to the identification of patients who would likely benefit from psychological support beginning already prior to their course of radiochemotherapy. Patients and MethodsIn this retrospective study, 57 patients scheduled for radiochemotherapy of WHO grade II-IV gliomas were investigated with respect to pre-treatment sleep problems. These patients had completed the National Comprehensive Cancer Network (NCCN) Distress Thermometer (14,15) between February 2019 and March 2021. The study was approved as a part of a larger project by the Ethics Committee of the University of Lübeck (reference 21-284). The technique to be used for the planned radiotherapy was volumetricmodulated arc therapy (VMAT). The preferred dose-frac...

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Kopelke

Kjær

Tvilsted

et al. 2021

In Vivo

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show abstract

“…Meyers and Wefel [ 26 ] opined that MMSE as a screening technique of NCF might fail to detect modest cognitive alterations because it lacks the sensitivity to identify frontal-subcortical network disruption, which is frequently associated with radiation therapy in the brain. The Montreal Cognitive Assessment is advocated to be a tool with higher sensitivity and greater comprehensive coverage for detecting even mild decline in NCF and has been used in studies of HGG patients [ 27 28 ]. However, it is dependent on the education levels of patients as it takes into account the years of education received and requires corrections to be made accordingly to eliminate bias.…”

Section: Discussionmentioning

confidence: 99%

“…With the trend of incorporating molecular and genetic markers into the classification and management of gliomas, newer risk factors have emerged which impact the NCF in these patients. In a large prospective analysis of 229 HGG patients receiving adjuvant CRT from China, Wang et al [ 28 ] found that apart from known prognostic factors like GBM histology and residual tumor volume, unmethylated O 6 -methylguanine-DNA methyltransferase (MGMT) promoter status also negatively impacted NCF in an independent manner. MGMT is a DNA repair protein and its unmethylated status in the tumor cells is known to cause resistance to TMZ chemotherapy with poorer survival [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With Neurocognitive Impairment Following Chemoradiotherapy in Patients With High-Grade Glioma: Results of a Prospective Trial

Sharma

Medhi

Kalita

et al. 2023

Brain Tumor Res Treat

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Background High-grade gliomas (HGG) are highly fatal tumors despite advanced multimodality management. They are also associated with neurocognitive impairment, both due to disease pathology and treatment. We aimed to assess various risk factors responsible for neurocognitive decline in HGG patients undergoing adjuvant chemoradiation. Methods Newly diagnosed HGG patients who underwent maximal safe resection were included. Patients received volumetric modulated arc therapy to a dose of 60 Gy in 30 fractions, along with concurrent temozolomide (TMZ) at a dose of 75 mg/m 2 /day orally; thereafter adjuvant TMZ (150–200 mg/m 2 for 5 days), given every 28 days for 6 to 8 cycles. The Mini-Mental State Examination questionnaire was used to measure cognitive impairment of each study patient at various time points. Cox regression model was used for univariate and multivariable analysis of data to establish possible risk factors. Results Fifty-three patients were enrolled and analyzed. At a median follow-up of 15 months, 30 patients (56.6%) developed cognitive impairment, and 23 patients (43.4%) did not. On univariate analysis, HGG with WHO grade 4, glioblastoma and diffuse midline glioma histology, IDH-wild type, recursive partitioning analysis class IV/V, and only biopsy of primary tumor were significantly associated with neurocognitive impairment, but none of them were independent risk factors on multivariable analysis. Planning target volume and dose received by ipsilateral hippocampus were also significantly correlated with cognitive decline in HGG patients. Conclusion Decline in neurocognitive functions in HGG patients is multifactorial and can be attributed to an amalgam of various tumor, patient, and treatment-related factors.

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“…In addition, cg18583565 is mapped to genes MGMT , which might be a risk factor for cognitive impairment (50), although the site is located to the gene body. Another probe (cg05065507) is mapped to the gene body of TACSTD2 ; overexpression of TACSTD 2 (also known as TROP2 ) has been reported in multiple cancers (47).…”

Section: Discussionmentioning

confidence: 99%

Epigenome-Wide Analysis of DNA Methylation and Optimism in Women and Men

et al. 2022

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ObjectiveHigher optimism is associated with reduced mortality and a lower risk of age-related chronic diseases. DNA methylation (DNAm) may provide insight into mechanisms underlying these relationships. We hypothesized that DNAm would differ among older individuals who are more versus less optimistic.MethodsUsing cross-sectional data from two population-based cohorts of women with diverse races/ethnicities (n = 3816) and men (only White, n = 667), we investigated the associations of optimism with epigenome-wide leukocyte DNAm. Random-effects meta-analyses were subsequently used to pool the individual results. Significantly differentially methylated cytosine-phosphate-guanines (CpGs) were identified by the “number of independent degrees of freedom” approach: effective degrees of freedom correction using the number of principal components (PCs), explaining >95% of the variation of the DNAm data (PC-correction). We performed regional analyses using comb-p and pathway analyses using the Ingenuity Pathway Analysis software.ResultsWe found that essentially all CpGs (total probe N = 359,862) were homogeneous across sex and race/ethnicity in the DNAm-optimism association. In the single CpG site analyses based on homogeneous CpGs, we identified 13 significantly differentially methylated probes using PC-correction. We found four significantly differentially methylated regions and two significantly differentially methylated pathways. The annotated genes from the single CpG site and regional analyses are involved in psychiatric disorders, cardiovascular disease, cognitive impairment, and cancer. Identified pathways were related to cancer, and neurodevelopmental and neurodegenerative disorders.ConclusionOur findings provide new insights into possible mechanisms underlying optimism and health.

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Risk Factors for Cognitive Impairment in High-Grade Glioma Patients Treated with Postoperative Radiochemotherapy

Cited by 12 publications

References 30 publications

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Risk Factors for Sleep Problems Prior to Radiochemotherapy for Malignant Gliomas

Factors Associated With Neurocognitive Impairment Following Chemoradiotherapy in Patients With High-Grade Glioma: Results of a Prospective Trial

Epigenome-Wide Analysis of DNA Methylation and Optimism in Women and Men

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