TY - JOUR
T1 - Risk factors for cognitive impairment in radically treated stage III NSCLC : Secondary findings of the NVALT-11 study
AU - Zeng, H.Y.
AU - Hendriks, L.E.L.
AU - Witlox, W.J.A.
AU - Groen, H.J.M.
AU - Dingemans, A.M.C.
AU - Praag, J.
AU - Belderbos, J.
AU - Houben, R.
AU - van der Noort, V.
AU - De Ruysscher, D.K.M.
N1 - Funding Information:
We sincerely thank the following grant for supporting us to complete this study: Scholarship of China Scholarship Council (Grant No. : CSC 201909370087). We sincerely thank all the researchers of NVALT-11trial for their efforts to conduct this trial successfully and the patients to participate in this trial.
Publisher Copyright:
© 2023 Elsevier B.V.
PY - 2023/6/1
Y1 - 2023/6/1
N2 - Aim: To identify risk factors for self-reported cognitive impairment in radically treated stage III non-small cell lung cancer (NSCLC). Methods: Cognitive functioning was assessed using the EORTC-QLQ-C30 at seven pre-specified time points in the phase III NVALT-11 trial (observation versus prophylactic cranial irradiation [PCI] in stage III NSCLC treated with chemo-radiotherapy +/- surgery). Cognition was analyzed as binary (impairment or not) and continuous outcome, respectively, using generalized estimating equation (GEE) before and after multiple imputation. A score < 75 was defined as cognitive impairment. A mean difference by < 10, 10-<20, >= 20 points was regarded as of no, moderate, and large clinical effect, respectively. We categorized the cognitive impairment into four types based on changes over time: sustained, rever-sible, recurring, and alternating. Results: In the no-PCI arm, 43/84 [51.2%] reported cognitive impairment at least once, of which 31.4% were sustained, 25.7% reversible, 28.6% recurring, and 14.3% alternating. Results were similar in the PCI arm. Cognitive functioning at baseline was comparable in two arms and a score < 75 was a significant risk factor with large effect for subsequent cognitive impairment (no-PCI: p = -23.30, p < 0.001; PCI arm: p = -22.34, p < 0.001; All: p = -23.47, p < 0.001). Younger age (<60y), squamous histology, and PCI were risk factors without clinical relevance (p >-10, p < 0.05). Cognitive functioning declined over time (p = -0.26, p = 0.001) except for patients with cognitive impairment at baseline (p = 0.141, p = 0.33). Conclusion: Cognitive impairment is dynamic over time with four types. Baseline cognitive impairment (score < 75) is the most important risk factor for subsequent cognitive impairment in stage III NSCLC. Note: This work has been partly reported as an oral presentation at the ESTRO 2021 meeting (OC-0176). (c) 2023 Elsevier B.V. All rights reserved. Radiotherapy and Oncology xxx (2023) xxx-xxx
AB - Aim: To identify risk factors for self-reported cognitive impairment in radically treated stage III non-small cell lung cancer (NSCLC). Methods: Cognitive functioning was assessed using the EORTC-QLQ-C30 at seven pre-specified time points in the phase III NVALT-11 trial (observation versus prophylactic cranial irradiation [PCI] in stage III NSCLC treated with chemo-radiotherapy +/- surgery). Cognition was analyzed as binary (impairment or not) and continuous outcome, respectively, using generalized estimating equation (GEE) before and after multiple imputation. A score < 75 was defined as cognitive impairment. A mean difference by < 10, 10-<20, >= 20 points was regarded as of no, moderate, and large clinical effect, respectively. We categorized the cognitive impairment into four types based on changes over time: sustained, rever-sible, recurring, and alternating. Results: In the no-PCI arm, 43/84 [51.2%] reported cognitive impairment at least once, of which 31.4% were sustained, 25.7% reversible, 28.6% recurring, and 14.3% alternating. Results were similar in the PCI arm. Cognitive functioning at baseline was comparable in two arms and a score < 75 was a significant risk factor with large effect for subsequent cognitive impairment (no-PCI: p = -23.30, p < 0.001; PCI arm: p = -22.34, p < 0.001; All: p = -23.47, p < 0.001). Younger age (<60y), squamous histology, and PCI were risk factors without clinical relevance (p >-10, p < 0.05). Cognitive functioning declined over time (p = -0.26, p = 0.001) except for patients with cognitive impairment at baseline (p = 0.141, p = 0.33). Conclusion: Cognitive impairment is dynamic over time with four types. Baseline cognitive impairment (score < 75) is the most important risk factor for subsequent cognitive impairment in stage III NSCLC. Note: This work has been partly reported as an oral presentation at the ESTRO 2021 meeting (OC-0176). (c) 2023 Elsevier B.V. All rights reserved. Radiotherapy and Oncology xxx (2023) xxx-xxx
KW - Cognitive impairment
KW - Non-small cell lung cancer (NSCLC)
KW - Multi-modality treatment
KW - Concurrent chemo-radiotherapy
KW - Multiple imputation-generalized estimating
KW - equation (MI-GEE)
KW - PROPHYLACTIC CRANIAL IRRADIATION
KW - QUALITY-OF-LIFE
KW - WHOLE-BRAIN RADIOTHERAPY
KW - RTOG 0212
KW - ONCOLOGY
KW - TRIAL
KW - MEMANTINE
KW - DECLINE
KW - IMPACT
U2 - 10.1016/j.radonc.2023.109627
DO - 10.1016/j.radonc.2023.109627
M3 - Article
C2 - 36934893
SN - 0167-8140
VL - 183
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 1
M1 - 109627
ER -