19 juli 2012: 2 Abstracten van Nederlandse studies en deeplink naar volledig studierapport over radiotherapie - bestraling van laaggradige gliomas toegevoegd.

Bron: The Lancet november 2002:

Intensivering van de bestralingen van een laaggradig glioom - een relatief niet zo vaak voorkomende vorm van een hersentumor in het steunweefsel van de hersenen - is geen goede en adekwate behandeling door de bijverschijnselen op langere termijn en het relatief niet directe levensgevaar voor mensen met deze vorm van hersentumoren. Dit schrijven Nederlandse onderzoekers in The Lancet van 2 november 2002.
Onderzoekscoördinator van deze studie en schrijver van het artikel is neuropsycholoog Dr. Martin Klein van het Medisch Centrum van de VU Amsterdam. Bij deze studie waren 195 patiënten betrokken verdeeld over 16 bestralingscentra in Nederland. Per jaar krijgen ca. 1000 mensen deze vorm van kanker in de hersenen. Een laaggradig glioom kan pas jaren later uitgroeien tot een kwaadaardige tumor, dit duurt soms zelfs tien tot twintig jaar. De klachten bij een laaggradig glioom, maar eigenlijk bij alle vormen van hersentumoren, is dat patiënten last krijgen van epileptische aanvallen. Deze worden behandeld met medicijnen - bv. dexamethason is een veel gebruikt medicijn bij hersentumoren - maar vaak ook worden patiënten bestraald.

Volgens Dr. Klein in de Volkskrant van 2 november is voor een totale bestralingsbehandeling, verdeeld over meestal 30 sessies, 60 gray (= dosis bestralingsbehandeling) nodig. In de studie is onderzocht - mede omdat er een tekort aan bestralingsapparatuur is en daardoor wachtlijsten - wat het effect van een grotere dosis en een verkorte intensievere behandeling zou teweeg brengen. Veel patiënten bleken nu vergeetachtig en verward te worden. De intensivering van de bestraling tastte de hersenfuncties meer aan dan bij een minder intensieve aanpak aldus de nu gepubliceerde studieresultaten . Conclusie uit de studie is dan ook dat intensivering van bestraling bij laaggradig glioom niet goed is.

Op de website van The Lancet kunt u het volledige studierapport tegen betaling inzien. Heir het abstract van de studie.

Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study

The Lancet, Volume 360, Issue 9343, Pages 1361 - 1368, 2 November 2002

doi:10.1016/S0140-6736(02)11398-5

Cite or Link Using DOI

Effect of radiotherapy and other treatment-related factors on mid-term to long-term cognitive sequelae in low-grade gliomas: a comparative study

Dr M Klein PhD a

, JJ Heimans MD b, NK Aaronson PhD e, HM van der Ploeg PhD a, J Grit MSc a, M Muller MSc e, TJ Postma MD b, JJ Mooij MD f, RH Boerman MD h, GN Beute MD i, GJ Ossenkoppele MD c, GW van Imhoff MD g, AW Dekker MD j, J Jolles PhD m, BJ Slotman MD d, H Struikmans MD k, MJB Taphoorn MD l

Summary

Background

Because survival benefits of treatment with radiotherapy are questionable and such treatment can cause substantial damage to the brain over time, the optimum management strategy for low-grade gliomas remains controversial. We aimed to identify the specific effects of radiotherapy on objective and self-reported cognitive function, and on cognitive deterioration over time, in patients with low-grade gliomas treated with early radiotherapy.

Methods

195 patients with low-grade glioma (of whom 104 had received radiotherapy 1—22 years previously) were compared with 100 low-grade haematological patients and 195 healthy controls. Our analyses aimed to differentiate between the effects of the tumour (eg, disease duration, lateralisation) and treatment effects (neurosurgery, radiotherapy, antiepileptic drugs) on cognitive function and on relative risk of cognitive disability.

Findings

Low-grade glioma patients had lower ability in all cognitive domains than did low-grade haematological patients, and did even less well by comparison with healthy controls. Use of radiotherapy was associated with poorer cognitive function; however, cognitive disability in the memory domain was found only in radiotherapy patients who received fraction doses exceeding 2 Gy. Antiepileptic drug use was strongly associated with disability in attentional and executive function.

Interpretation

Our findings suggest that the tumour itself has the most deleterious effect on cognitive function and that radiotherapy mainly results in additional long-term cognitive disability when high fraction doses are used. Additionally, the effects of other medical factors, especially antiepileptic drug use, on cognitive function in glioma patients deserve attention.

Is there a place for radiotherapy in low-grade gliomas?

Adv Tech Stand Neurosurg. 2010;35:159-82.

Is there a place for radiotherapy in low-grade gliomas?

Baumert BG, Stupp R.

Source

Department of Radiation-Oncology (MAASTRO), Grow (School for Oncology and Developmental Biology), Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands.

Abstract

The optimal management of supratentorial low-grade glioma remains controversial, and only limited definitive data is available to guide recommendations. Treatment decisions have to take into account both the management of symptoms and of tumour control, and must balance the benefits against the potential for treatment-related complications. Overall outcome is more dependent on patient and tumour-related characteristics such as age, tumour grade, histology and neurological function than treatment. From the pooled analysis of 2 randomized EORTC trials a prognostic score has been derived, median survival is varying from 3.2 to 7.8 years. Radiation therapy is usually the primary treatment modality; however its benefit on initial tumour control may be outweighed by potential late toxicity. To date only 4 large randomized trials in patients with low-grade glioma have been reported. It allows concluding that early radiotherapy does not improve overall survival and supports an initially expectative approach. Similarly, higher radiation doses above 45-50 Gy (fractions of 1.8-2.0 Gy) do not confer a better outcome but may be associated with increased toxicity. The adjuvant use of PCV-chemotherapy in high-risk patients also failed to improve progression-free and overall survival. An ongoing large randomized EORTC/NCIC trial is investigating the primary treatment with temozolomide chemotherapy versus standard radiotherapy in patients "at need for treatment". Tumour material will be collected in all patients, which ultimately may allow identifying on a molecular basis patients for whom one or another treatment strategy may fit best. Irrespective of new chemotherapeutic agents, radiotherapy is also evolving. Highly conformal techniques based on modern imaging as co-registered MRI scans, limiting the amount of normal tissue irradiated without compromising tumour control, will be the future approach in order to reduce neurotoxicity.