Initial PCV Chemotherapy Followed by Radiotherapy Is Associated With a Prolonged Response But Late Neurotoxicity in...

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Clinical Neurology

Background:

• Diffuse low-grade gliomas (DLGGs) are challenging to treat.
• The RTOG 9802 study suggested a survival benefit for the procarbazine, CCNU, and vincristine (PCV) plus radiotherapy (RT) combination.
• Limited data exist on the long-term neurocognitive impact and quality of life (QoL) associated with this treatment.

Purpose of the Study:

• To evaluate the long-term neurocognitive effects and quality of life (QoL) in patients with high-risk diffuse low-grade gliomas (DLGGs) treated with PCV-RT.
• To analyze radiological outcomes and survival in a monocentric series of DLGG patients.

Main Methods:

• A monocentric series of 20 DLGG patients treated with upfront PCV-RT from 1982-2017 were analyzed.
• Radiological data including volume and velocity of diametric expansion (VDE) were collected.
• Long-term neurocognitive function, QoL, and survival were assessed.

Main Results:

• The median follow-up was 17.5 years, with an estimated median survival of 17.4 years.
• Significant long-term neurotoxicity was observed, including dementia in 30% of patients and verbal episodic memory deterioration.
• 65% of patients experienced disability, impacting their ability to work.

Conclusions:

• The PCV-RT combination demonstrates oncological synergy but also considerable long-term neurotoxicity.
• This neurotoxicity, including dementia and cognitive decline, must be considered in therapeutic decisions for DLGGs.
• Further research is needed to balance treatment efficacy with neurocognitive preservation.