Neuropsychological effects of fractionated, stereotactic radiation therapy (FSRT) in patients with meningiomas

William Levin, MD
OncoLink Assistant Editor
Last Modified: October 23, 2000

Presenter: G. Welzel
Affiliation: University of Heidelberg

Summary:

Meningiomas are benign, slow growing tumors with a good survival rate after radiotherapy. Neurotoxicity after irradiation of the central nervous system is widely discussed and of special interest in patients with meningiomas. The purpose of this study was to examine effects of irradiation on cognitive abilities in patients with meningiomas.

Methods:

37 patients were tested (see below for test types) immediately before the start of radiotherapy (RT), 1 day after beginning radiotherapy (acute phase), at the end of RT, 6 weeks (subacute phase), and 6 months after completion of therapy (chronic phase).
All patients were treated with FSRT at 1.8 Gy/day with total doses between 54.0 and 68.4 Gy (median, 57.6 Gy).
A standardized test battery including general intelligence, memory, and attention was administered.

Results:

In the acute phase, significant improvements in attention functions were seen.
In contrast, significant deteriorations of verbal memory functions were detected in the acute phase.
At the end of radiotherapy, verbal memory functions recovered to baseline level and attention functions improved.
Six months after completion of irradiation significant improvements in memory and attention functions were seen in all patients.

Author's Conclusions:

Patients with meningiomas show transient deteriorations of memory functions and improvements of attention functions after radiotherapy.
The improvements of attention functions in the acute phase of radiotherapy was attributed to a practice effect, i.e.. taking the test for a second time.
Deteriorations of attention and memory functions could reflect an increase in peritumor edema.
Decreases in memory in the subacute phase could be caused by nerve cell demyelinization.

Clinical/Scientific Implications:

The effects of radiotherapy on the cognitive functions of patients receiving brain irradiation must continue to be monitored and studied, particularly in those patients with an expected long-term survival.