The JLA Neuro-Oncology Priority Setting Partnership (link) identified the question What are the long term physical and cognitive effects of surgery and radiotherapy when treaing people with bran or spinal cord tumour, compared with standard care?”
This area is therefore now a priority area for clinical research. By understanding the potential adverse effects, treatment can be modified to minimise them.
Surgery will either take a sample of a tumour (biopsy) to try and establish the nature of it for diagnosis and to direct further specific therapy, or will attempt to remove part or all of the tumour to try to improve symptoms and reduce the number of remaining cells, therefore hopefully making treatment more effective. Neurosurgery may however be associated with neurological worsening or death. Where neurological worsening occurs, it does not always resolve and people may be left with problems with memory, personality, weakness, sensory loss, language or visual difficulty depending on where the tumour is situated.
Radiotherapy has evolved empirically, with progressive technical improvements, which contribute to improved clinical outcomes as either a better cure rate, or reduced complication rate, or both – in some cancers. Cognitive difficulties specifically following brain tumour treatment have been reported, particularly associated with more aggressive treatment regimes. Because radiotherapy treatment for brain tumour patients can cause substantial damage to the brain over time, the optimum management strategy for brain tumours remains uncertain. We have an imprecise knowledge of the relative biological effect (RBE) for different tissues and tumours, and at different doses. Toxic effects of radiotherapy may be worsened by the additional use of chemotherapy.
As anti-cancer treatments become more effective and available, patients will live longer disease-free but with long-term sequelae of the disease and the neurotoxic side effects of treatment.
Greater emphasis is now being placed on quality of life and with the establishment of neurocognitive function as a predictor of survival and quality of life, cognitive functioning is an essential outcome measure. A recent Cochrane Review of the interventions for cognitive problems specifically associated with cranial irradiation in adult cancer survivors has shown that further research is needed
The NCRI will hold an “Incubator Day” in 2016, to examine the current stage of research and advise on best design of any future study in the area. This will be lead by the NCRI Brain Clinical Studies Group and NCRI Primary Care CSG.
If interested in supporting this research area, or learning more, please contact the NCRI Brain Supportive & Palliative Care Group and leave details of your interest. (email: S&PC@neuro-oncology.org.uk)