Neurocognitive functioning and health-related quality of life in adult medulloblastoma patients: long-term outcomes of the NOA-07 study

• Published in: Journal of neuro-oncology Vol. 148; no. 1; pp. 117 - 130
• Main Authors: Dirven, Linda, Luerding, Ralf, Beier, Dagmar, Bumes, Elisabeth, Reinert, Christiane, Seidel, Clemens, Bonsanto, Matteo Mario, Bremer, Michael, Rieken, Stefan, Combs, Stephanie E., Herrlinger, Ulrich, Seliger, Corinna, Kuntze, Holger, Mayer-Steinacker, Regine, Dieing, Annette, Bartels, Claudius, Schnell, Oliver, Weyerbrock, Astrid, Seidel, Sabine, Grauer, Oliver, Nadji-Ohl, Minou, Paulsen, Frank, Weller, Michael, Wick, Wolfgang, Hau, Peter
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.05.2020; Springer Nature B.V
• Subjects: Adult; Brain cancer; Cerebellar Neoplasms - psychology; Cerebellar Neoplasms - therapy; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Chemotherapy; Cisplatin; Clinical Study; Cognition; Cognitive ability; Combined Modality Therapy - adverse effects; Female; Humans; Information processing; Language; Maintenance Chemotherapy - adverse effects; Male; Medicine; Medicine & Public Health; Medulloblastoma; Medulloblastoma - psychology; Medulloblastoma - therapy; Memory; Middle Aged; Neurology; Neuropsychological Tests; Oncology; Quality of Life; Short term memory; Toxicity; Treatment Outcome; Vincristine; Young Adult; Brain tumor; Patient-reported outcome; Cognition; Toxicity; Medulloblastoma; Quality of life
• ISSN: 0167-594X; 1573-7373
• DOI: 10.1007/s11060-020-03502-y

Background Combined radiochemotherapy followed by maintenance chemotherapy with cisplatin, lomustine and vincristine within the NOA-07 study resulted in considerable short-term toxicity in adult medulloblastoma patients. Here we investigated the long-term impact of this treatment, focusing on neurocognitive functioning and health-related quality of life (HRQoL). Methods Neurocognitive functioning and HRQoL scores over time were determined, and differences between the post-treatment and follow-up assessments were calculated up to 18 months for neurocognition and 60 months for HRQoL. Results 28/30 patients were analyzed. The three preselected HRQoL scales (role, social and cognitive functioning) showed improved scores, to a clinically relevant extent (≥ 10 points), compared to post-treatment levels up to 30 months, but decreased afterwards. Z-scores for verbal working memory were worse during follow-up compared to post-treatment scores and remained impaired during 18 months follow-up (i.e. z-score below − 1 standard deviation). Attention was impaired post-treatment, and remained impaired to a clinically relevant extent during follow-up. Coordination/processing speed and lexical verbal fluency improved compared to post-treatment scores, and remained within the normal range thereafter. Other tests of verbal fluency were stable over time, with z-scores within the normal range. Conclusions This long-term follow-up study showed that the NOA-07 treatment regimen was not associated with a deterioration in HRQoL in the post-treatment period. Verbal working memory deteriorated, while other neurocognitive domains did not seem to be impacted negatively by the treatment.