본문 바로가기
KERD
논문KCI 등재

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

1

조회

0

다운로드

1

인용

0

참고문헌

키워드

주제분류의학일반

초록

Purpose Fractionated radiotherapy as well as concomitant and adjuvant chemotherapy such as temozolomide for postoperative high-grade glioma (HGG) patients improves progressionfree survival and overall survival. Multiple factors such as chemotherapy, radiotherapy, tumor grade, residual tumor volume, and genetic modifications might play a role in the formation of cognitive impairment. The risk factors of cognitive impairment in postoperative patients with HGG receiving radiotherapy and chemotherapy remains a concern in this population. The purpose of this study was to identify risk factors for cognitive impairment in patients of postoperative HGG. Materials and Methods A total of 229 patients with HGG who underwent surgery were analyzed. Cognitive impairment was defined as a decrease of Cognitive Assessment Montreal (MoCA)’s score in at least two cognitive domains or any MoCA’s score of less than 26 points at the time of study compared with baseline level. Multiple potential risk factors including methylated status of the O6-methylguanine-DNA methyltransferase (MGMT) promoter, glioma World Health Organization (WHO) grade, residual tumor volume, education, and sex were analyzed. Cox univariate and multivariate regression analysis was used to detect the significant risk factors for cognitive impairment. Results At the end of follow-up among the 229 patients, 147 patients (67%) developed cognitive impairment. 82 patients (36%) remained in normal cognitive condition. In multivariate analysis, unmethylated MGMT promoter (hazard ratio [HR], 1.679; 95% confidence interval [CI], 1.212 to 2.326; p=0.002), glioblastoma (HR, 1.550; 95% CI, 1.117 to 2.149; p=0.009), and residual tumor volume > 5.58 cm3 (HR, 1.454; 95% CI, 1.047 to 2.020; p=0.026) were independent risk factors for cognitive impairment. Conclusion Methylated status of the MGMT promoter, glioma WHO grade, and residual tumor volume might be risk factors for the cognitive impairment in postoperative patients with HGG.

Abstract

Purpose Fractionated radiotherapy as well as concomitant and adjuvant chemotherapy such as temozolomide for postoperative high-grade glioma (HGG) patients improves progressionfree survival and overall survival. Multiple factors such as chemotherapy, radiotherapy, tumor grade, residual tumor volume, and genetic modifications might play a role in the formation of cognitive impairment. The risk factors of cognitive impairment in postoperative patients with HGG receiving radiotherapy and chemotherapy remains a concern in this population. The purpose of this study was to identify risk factors for cognitive impairment in patients of postoperative HGG. Materials and Methods A total of 229 patients with HGG who underwent surgery were analyzed. Cognitive impairment was defined as a decrease of Cognitive Assessment Montreal (MoCA)’s score in at least two cognitive domains or any MoCA’s score of less than 26 points at the time of study compared with baseline level. Multiple potential risk factors including methylated status of the O6-methylguanine-DNA methyltransferase (MGMT) promoter, glioma World Health Organization (WHO) grade, residual tumor volume, education, and sex were analyzed. Cox univariate and multivariate regression analysis was used to detect the significant risk factors for cognitive impairment. Results At the end of follow-up among the 229 patients, 147 patients (67%) developed cognitive impairment. 82 patients (36%) remained in normal cognitive condition. In multivariate analysis, unmethylated MGMT promoter (hazard ratio [HR], 1.679; 95% confidence interval [CI], 1.212 to 2.326; p=0.002), glioblastoma (HR, 1.550; 95% CI, 1.117 to 2.149; p=0.009), and residual tumor volume > 5.58 cm3 (HR, 1.454; 95% CI, 1.047 to 2.020; p=0.026) were independent risk factors for cognitive impairment. Conclusion Methylated status of the MGMT promoter, glioma WHO grade, and residual tumor volume might be risk factors for the cognitive impairment in postoperative patients with HGG.

참고문헌 (30)

  1. Ostrom QT, "CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008-2012", Neuro Oncol, 17(Suppl 4), pp.iv1~iv62 (2015)
  2. Klein M, "Neurobehavioral status and healthrelated quality of life in newly diagnosed high-grade glioma patients", J Clin Oncol, 19, pp.4037~4047 (2001)
  3. Tucha O, "Cognitive deficits before treatment among patients with brain tumors", Neurosurgery, 47, pp.324~333 (2000)
  4. Sarkissian V, "The sequelae of cranial irradiation on human cognition", Neurosci Lett, 382, pp.118~123 (2005)
  5. Armstrong CL, "Late cognitive and radiographic changes related to radiotherapy : initial prospective findings", Neurology, 59, pp.40~48 (2002)
  6. Wang M, "Cognition and quality of life after chemotherapy plus radiotherapy (RT) vs. RT for pure and mixed anaplastic oligodendrogliomas: radiation therapy oncology group trial 9402", Int J Radiat Oncol Biol Phys, 77, pp.662~669 (2010)
  7. Laack NN, "Cognitive function after radiotherapy for supratentorial low-grade glioma : a North Central Cancer Treatment Group prospective study", Int J Radiat Oncol Biol Phys, 63, pp.1175~1183 (2005)
  8. Klein M, "Effect of radiotherapy and other treatmentrelated factors on mid-term to long-term cognitive sequelae in low-grade gliomas : a comparative study", Lancet, 360, pp.1361~1368 (2002)
  9. Verger E, "Temozolomide and concomitant whole brain radiotherapy in patients with brain metastases : a phase II randomized trial", Int J Radiat Oncol Biol Phys, 61, pp.185~191 (2005)
  10. Antonadou D, "Phase II randomized trial of temozolomide and concurrent radiotherapy in patients with brain metastases", J Clin Oncol, 20, pp.3644~3650 (2002)
  11. Saito K, "Toxicity and outcome of radiotherapy with concomitant and adjuvant temozolomide in elderly patients with glioblastoma : a retrospective study", Neurol Med Chir(Tokyo), 54, pp.272~279 (2014)
  12. Nasreddine ZS, "The Montreal Cognitive Assessment, MoCA : a brief screening tool for mild cognitive impairment", J Am Geriatr Soc, 53, pp.695~699 (2005)
  13. Smith T, "The Montreal Cognitive Assessment : validity and utility in a memory clinic setting", Can J Psychiatry, 52, pp.329~332 (2007)
  14. Wang Q, "A prospective longitudinal evaluation of cognition and depression in postoperative patients with high-grade glioma following radiotherapy and chemotherapy", J Cancer Res Ther., 14(Suppl), pp.S1048~S1051 (2018)
  15. Durand T, "EpiBrainRad : an epidemiologic study of the neurotoxicity induced by radiotherapy in high grade glioma patients", BMC Neurol, 15, pp.261~ (2015)
  16. Dhermain F, "Radiotherapy of high-grade gliomas: current standards and new concepts, innovations in imaging and radiotherapy, and new therapeutic approaches", Chin J Cancer, 33, pp.16~24 (2014)
  17. 김병섭, "Concurrent Chemoradiotherapy with Temozolomide Followed by Adjuvant Temozolomide for Newly Diagnosed Glioblastoma Patients: A Retrospective Multicenter Observation Study in Korea", Cancer Research and Treatment, 49(1), pp.193~203 (2017), 대한암학회
  18. Kole AJ, "Concurrent chemoradiotherapy versus radiotherapy alone for"biopsy-only"glioblastoma multiforme", Cancer, 122, pp.2364~2370 (2016)
  19. Woo PY, "Determining a cut-off residual tumor volume threshold for patients with newly diagnosed glioblastoma treated with temozolomide chemoradiotherapy : a multicenter cohort study", J Clin Neurosci, 63, pp.134~141 (2019)
  20. Yang K, "Cancer genetic markers according to radiotherapeutic response in patients with primary glioblastoma : radiogenomic approach for precision medicine", Radiother Oncol, 131, pp.66~74 (2019)
  21. Wefel JS, "Neurocognitive function varies by IDH1 genetic mutation status in patients with malignant glioma prior to surgical resection", Neuro Oncol, 18, pp.1656~1663 (2016)
  22. Kesler SR, "The effect of IDH1 mutation on the structural connectome in malignant astrocytoma", J Neurooncol, 131, pp.565~574 (2017)
  23. Jiang X, "O6-methylguanine-DNA methyltransferase(MGMT)immunohistochemistry as a predictor of resistance to temozolomide in primary CNS lymphoma", J Neurooncol, 114, pp.135~140 (2013)
  24. Binabaj MM, "The prognostic value of MGMT promoter methylation in glioblastoma : a meta-analysis of clinical trials", J Cell Physiol, 233, pp.378~386 (2018)
  25. Smrdel U, "Long-term survival in glioblastoma : methyl guanine methyl transferase(MGMT)promoter methylation as independent favourable prognostic factor", Radiol Oncol, 50, pp.394~401 (2016)
  26. Liu Y, "Genetic modulation of neurocognitive function in glioma patients", Clin Cancer Res, 21, pp.3340~3346 (2015)
  27. Miotto EC, "Cognitive impairments in patients with low grade gliomas and high grade gliomas", Arq Neuropsiquiatr, 69, pp.596~601 (2011)
  28. Noll KR, "Relationships between tumor grade and neurocognitive functioning in patients with glioma of the left temporal lobe prior to surgical resection", Neuro Oncol, 17, pp.580~587 (2015)
  29. Surma-aho O, "Adverse long-term effects of brain radiotherapy in adult low-grade glioma patients", Neurology, 56, pp.1285~1290 (2001)
  30. Talacchi A, "Cognitive effects of tumour and surgical treatment in glioma patients", J Neurooncol, 103, pp.541~549 (2011)

관련 논문AI추천

To Use or Not to Use: Temozolomide in Elderly Patients with IDH Wild-Type MGMT Promoter Unmethylated Glioblastoma Treated with Radiotherapy강석구, 김의현, 김인아, 김지나, 김채용, 문주형, 박철기, 위찬우, 윤홍인, 이주호, 이혜인, 장종희, 조재호, 황기환대한암학회 · Cancer Research and Treatment2025 · 제57권 제3호High Radiation Dose to the Fornix Causes Symptomatic Radiation Necrosis in Patients with Anaplastic Oligodendroglioma강석구, 김태형, 문주형, 박예원, 서창옥, 윤홍인, 장종희, 조재호연세대학교의과대학 · Yonsei Medical Journal2024 · 제65권 제1호Concurrent Chemoradiotherapy with Temozolomide Followed by Adjuvant Temozolomide for Newly Diagnosed Glioblastoma Patients: A Retrospective Multicenter Observation Study in Korea유헌, 강민규, 강석구, 강신혁, 곽호신, 김병섭, 김선환, 김세훈, 김은영, 김의현, 김인아, 김일한, 김재용, 김정훈, 김진희, 김태민, 남도현, 박철기, 서창옥, 설호준, 송준호, 안국진, 윤상민, 이경화, 이선일, 이세훈, 이연수, 임도훈, 장종희, 정동섭, 정태영, 조성진, 조영현, 홍용길, 홍창기, 황선철대한암학회 · Cancer Research and Treatment2017 · 제49권 제1호Clinical Outcomes of Moderately Hypofractionated Concurrent Chemoradiotherapy for Newly Diagnosed Glioblastoma공두식, 남도현, 설호준, 이정일, 임도훈, 최정원, Nalee Kim연세대학교의과대학 · Yonsei Medical Journal2023 · 제64권 제2호Choosing Wisely Between Radiotherapy Dose-Fractionation Schedules: The Molecular Graded Prognostic Assessment for Elderly Glioblastoma Patients김인아, 김지나, 위찬우, 윤홍인, 이주호, 이혜인, 조재호, Geoffrey Fell, Rifaquat Rahman대한암학회 · Cancer Research and Treatment2025 · 제57권 제2호Hypofractionated Re-irradiation after Maximal Surgical Resection for Recurrent Glioblastoma: Therapeutic Adequacy and Its Prognosticators of Survival서창옥, 안성수, 이정심, 장종희연세대학교의과대학 · Yonsei Medical Journal2018 · 제59권 제2호

이 간행물의 다른 논문 (29건)