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Low-grade gliomas, which compose up to 40% of all intracranial gliomas in adults, are often relatively localized at the time of diagnosis.1 Therapeutic options include observation, surgical resection, local radiotherapy, and most recently, chemotherapy. A major issue in the management of intracerebral low-grade gliomas is whether earlier treatment, be it with aggressive surgery, chemotherapy, or local radiotherapy, improves outcome.2 It is unclear whether early intervention results in transient or permanent deterioration of neurologic function and, thus, outweighs the potential benefits of early treatment.
Uncertainty surrounds the effectiveness and safety of radiotherapy. Whole brain radiotherapy results in significant, usually progressive, cognitive decline in children with cancer, and doses greater 2,000 cGy in children with leukemia and medulloblastoma cause a measurable decrease in cognition. Thirty-six hundred cGy will result in a 20- to 30-point decline in IQ score over a 3- to 4-year period in children with medulloblastoma between 3 and 7 years of age.3 However, the cognitive sequelae of whole brain radiotherapy are not well delineated in adults and the potential detrimental effects of partial brain radiotherapy is even less well characterized.4-7⇓⇓⇓ Two articles in this issue of Neurology address the effects of local brain radiotherapy. Armstrong et al.8 describe the cognitive and radiographic outcome of 26 patients with low-grade, supratentorial brain tumors followed prospectively for up to 6 years. Postma et al.9 evaluated neuroradiographic abnormalities and neuropsychological performance in 49 patients with low-grade gliomas, 23 of whom had been treated with local radiotherapy. Armstrong et al.8 did not find a general cognitive …
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