Long-term neurocognitive and psychological outcomes in meningioma survivors: Individual changes over time and radiation dosimetry

Angela Sekely; Konstantine K Zakzanis; Donald Mabbott; Derek S Tsang; Paul Kongkham; Gelareh Zadeh; Kim Edelstein

doi:10.1093/nop/npad072

Long-term neurocognitive and psychological outcomes in meningioma survivors: Individual changes over time and radiation dosimetry

Neurooncol Pract. 2023 Nov 5;11(2):157-170. doi: 10.1093/nop/npad072. eCollection 2024 Apr.

Authors

Angela Sekely^{1

2}, Konstantine K Zakzanis^{1

3}, Donald Mabbott^{3

4}, Derek S Tsang^{5

6}, Paul Kongkham⁷, Gelareh Zadeh⁷, Kim Edelstein^{1

2

8}

Affiliations

¹ Graduate Department of Psychological Clinical Science, University of Toronto, Toronto, Ontario, Canada.
² Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
³ Department of Psychology, University of Toronto, Toronto, Ontario, Canada.
⁴ Department of Psychology, Neurosciences, and Mental Health Program, Hospital for Sick Children, Toronto, Ontario, Canada.
⁵ Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
⁶ Division of Haematology/Oncology, Hospital for Sick Children, Toronto, Ontario, Canada.
⁷ Division of Neurosurgery, Department of Surgery, Toronto Western Hospital, Toronto, Ontario, Canada.
⁸ Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.

PMID: 38496914
PMCID: PMC10940838 (available on 2024-11-05)
DOI: 10.1093/nop/npad072

Abstract

Background: This study investigates long-term changes in neurocognitive performance and psychological symptoms in meningioma survivors and associations with radiation dose to circumscribed brain regions.

Methods: We undertook a retrospective study of meningioma survivors who underwent longitudinal clinical neurocognitive assessments. Change in neurocognitive performance or psychological symptoms was assessed using reliable change indices. Radiation dosimetry, if prescribed, was evaluated based on treatment-planning computerized tomography co-registered with contrast-enhanced 3D T1-weighted magnetic resonance imaging. Mixed effects analyses were used to explore whether incidental radiation to brain regions outside the tumor influences neurocognitive and psychological outcomes.

Results: Most (range = 41%-93%) survivors demonstrated stable-albeit often below average-neurocognitive and psychological trajectories, although some also exhibited improvements (range = 0%-31%) or declines (range = 0%-36%) over time. Higher radiation dose to the parietal-occipital region (partial R² = 0.462) and cerebellum (partial R² = 0.276) was independently associated with slower visuomotor processing speed. Higher dose to the hippocampi was associated with increases in depression (partial R² = 0.367) and trait anxiety (partial R² = 0.236).

Conclusions: Meningioma survivors experience neurocognitive deficits and psychological symptoms many years after diagnosis, and a proportion of them decline over time. This study offers proof of concept that incidental radiation to brain regions beyond the tumor site may contribute to these sequelae. Future investigations should include radiation dosimetry when examining risk factors that contribute to the quality of survivorship in this growing population.

Keywords: anxiety; brain tumor depression; longitudinal; meningioma; neuropsychology.

© The Author(s) 2023. Published by Oxford University Press on behalf of the Society for Neuro-Oncology and the European Association of Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.