Central Nervous System

PD 03 - CNS 1 - Poster Discussion - Toxicity and Quality of Life

1023 - TRAIT (Treatment-Related Alterations In Thinking): A Prospective Longitudinal Study Assessing Mild Cognitive Impairment in Irradiated Brain Tumor Patients

Sunday, October 21
5:15 PM - 5:21 PM
Location: Room 217 A/B

TRAIT (Treatment-Related Alterations In Thinking): A Prospective Longitudinal Study Assessing Mild Cognitive Impairment in Irradiated Brain Tumor Patients
C. K. Cramer1, W. H. Wheless2, E. McTyre1, S. Isom3, W. Hinson4, S. R. Rapp5, L. D. Case3, T. L. Cummings6, G. J. Lesser7, M. D. Chan1, E. G. Shaw8, C. T. Whitlow9, and A. M. Peiffer10; 1Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 2Wake Forest School of Medicine, Winston-Salem, NC, 3Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, 4Wake Forest Baptist Medical Center, Winston Salem, NC, 5Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 6Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, 7Department of Hematology & Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 8Department of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, NC, 9Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 10Wake Forest Baptist Medical Center, Winston-Salem, NC

Purpose/Objective(s): Radiation-induced cognitive decline (RICD) is a late effect of brain radiation therapy (RT) occurring in a substantial number of brain tumor survivors. The aim of this study was to 1) report the incidence of Mild Cognitive Impairment (MCI) after RT with prospectively collected cognitive data and 2) evaluate patient characteristics and dosimetric parameters associated with development of MCI after RT.

Materials/Methods: Patients ≥ 18 years old with primary and metastatic brain tumors scheduled to receive ≥ 30 Gy and with a life expectancy > 12 months were eligible. Patients participated in a cognitive battery measuring memory, attention, executive function, visuospatial ability, and dexterity prior to RT and 1, 3, 6, 12, and 24 months after RT (CCCWFU #98511). For this analysis, patients were designated as MCI or non-MCI at each time point using standardized criteria that included a subjective cognitive complaint on the FACT-Brain scale and a cognitive deficit ≥ 1.5 SD below norm on ≥ 1 cognitive test without any functional impairment in performing activities of daily living. Patients were categorized as never MCI, baseline MCI, transient MCI (became MCI but then recovered to non-MCI status), and persistent MCI (became and remained MCI). Baseline patient characteristics and cognitive data were compared between groups using t, Kruskal-Wallis, and exact tests. For dosimetric analysis, anatomic segmentation of regions of interest was performed by registering each baseline T1 MRI and RT dose file to a template brain atlas and manually edited for accuracy. Logistic regression was performed in a voxelwise fashion for the binary outcome of MCI category vs. dose.

Results: From 2012-14, 33 patients were enrolled. 60% were female and 40% male with a mean age of 49. 55% had 12-16 years of education. 32 patients had baseline and post-RT cognitive data and were eligible for analysis. At baseline pre-RT, 5 (16%) met criteria for MCI. 10 (32%) patients were categorized as never MCI, 4 (12.5%) as transient MCI, and 13 (40%) as persistent MCI. No demographic variables were statistically different between groups. Baseline measures of attention and executive function (Trail Making A & B scores) were statistically higher in the never MCI patients v. persistent MCI patients (p=0.0235 and 0.0054). Voxelwise logistic regression for MCI category v. dose showed a significant relationship (p<0.05) in the precentral gyrus, insular cortex, precuneus cortex, corpus callosum, posterior cingulate gyrus, subventricular zones, and hippocampi.

Conclusion: In this cohort, patients who developed MCI after RT had statistically lower scores at baseline on measures of attention and executive function compared to those who maintained normal cognition. Multiple anatomic regions within the brain showed a dose-dependent relationship with the development of post-RT MCI.

Author Disclosure: C.K. Cramer: Honoraria; Qfix. W.H. Wheless: None. E. McTyre: Employee; Wake Forest University Baptist Medical Center. S. Isom: None. W. Hinson: None. T.L. Cummings: None. G.J. Lesser: None. M.D. Chan: Honoraria; Elekta. Advisory Board; Novocure.

Christina Cramer, MD

Wake Forest Baptist Medical Center

Disclosure:
Compensation
Qfix: Honoraria

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