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From the Departments of Neurosurgery (Drs. Niemelä, Vilkki, and Jääskeläinen, and O. Surma-aho), Oncology (Dr. Kouri and J. Pyykkönen), Radiology (Drs. Brander and Salonen), and Neurology (Dr. Kallio), Helsinki University Hospital; and the Department of Pathology (Dr. Paetau), Haartman Institute; and Department of Psychology (Dr. Vilkki), University of Helsinki, Finland.
Address correspondence and reprint requests to Outi Surma-aho, Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland; e-mail: outi.surma-aho{at}hus.fi
OBJECTIVE: To study the long-term effects of radiotherapy on cognitive function in adult patients operated on for low-grade glioma.
METHODS: A cohort of 160 patients who underwent surgery for low-grade gliomas of cerebral hemisphere between 1980 and 1992 in a single institution serving a defined population was studied. At a mean follow-up time of 7 years, 28 of the 101 patients who had postoperative irradiation (and no second surgery or chemotherapy) were still alive and eligible for MRI and neuropsychological study. Twenty-three of 59 patients who did not have radiotherapy, second surgery, or chemotherapy were alive and eligible at a mean of 10 years.
RESULTS: The group that had postoperative irradiation performed significantly worse than the group that did not in cognitive tests. This difference was not accounted for by histologic diagnosis; location, extent of removal, or progression of the tumor; or any patient factor. Leukoencephalopathy was more severe in the group that had postoperative irradiation than in the group without radiotherapy, and correlated to poor memory performances only in the postoperative radiotherapy group. Average Karnofsky performance scale score was significantly lower in the group that had postoperative irradiation than in the group that did not.
CONCLUSION: In adults with low-grade glioma, postoperative radiotherapy poses a significant risk of long-term leukoencephalopathy and cognitive impairment.
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