Treatment options and neurocognitive outcome in patients with diffuse low-grade glioma

In the management of patients with low-grade glioma (LGG) there still is controversy on how surgical intervention, radiotherapy, and chemotherapy contribute to an ameliorated progression-free survival, overall survival, and treatment-related neurotoxicity. With the ongoing changes in treatment options for these patients, neurocognitive functioning is an increasingly important outcome measure, because neurocognitive impairments can have a large impact on self-care, social and professional functioning, and consequently on health-related quality of life. Many factors contribute to neurocognitive outcome, such as direct and indirect tumor effects, seizures, medication, and oncological treatment. Although the role of radiotherapy has been studied extensively, the adverse effects on neurocognitive function of other treatment-related factors remain elusive. This not only holds for resective surgery, where the use of intraoperative stimulation mapping has a high potential benefit concerning survival and patient functioning, but also for the use of chemotherapy that might have some interesting new applications, like the facilitation of total resection for initially primary or recurrent diffuse LGG tumors. This paper will discuss these treatment options in LGG patients and their potential effects on neurocognitive functioning.