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Effects of radiation therapy on adult brain behavior

Evidence for a rebound phenomenon in a phase 1 trial

From the Departments of Neurology (Drs. Armstrong, Mollman, and Grossman), Radiation Oncology (Dr. Corn), and Hematology/Oncology (Dr. Alavi), University of Pennsylvania Medical Center, Philadelphia, PA.

Although radiotherapy (XRT) is a necessary course of treatment to prolong life expectancy in patients with many types of brain neoplasms, it has damaging effects that are little understood. We used a comprehensive neuropsychological battery to evaluate five patients with low-grade brain tumors prior to XRT and then at 3-month intervals up to 9 months postcompletion of XRT. We matched patients by age and education with six normal control subjects to assess baseline impairment. In intrasubject comparisons, we examined change over time postcompletion of XRT. In spite of varying locations of tumors, all patients showed deterioration in long-term memory at a mean of 1.5 months postcompletion of XRT. Patients also consistently demonstrated a rebound effect between means of 4.7 and 7.6 months post-XRT. We found no changes over time in working memory, attention, visuospatial processes, or on any other neuropsychological test with the exception of information-processing speed, which quickened over time. Functional measures of fatigue and mood did not correlate significantly with the long-term memory scores. Long-term memory appears sensitive to the proposed white matter changes thought to be the mechanism for the early-delayed effects of XRT. Our findings suggest a neurobehavioral model for studying the effects of XRT on brain functioning.

Address correspondence and reprint requests to Dr. Carol Armstrong, Department of Neurology, University of Pennsylvania Medical Center, 3400 Spruce Street, Philadelphia, PA 19104-4283.

Presented in part at the 44th annual meeting of the American Academy of Neurology, San Diego, CA, May 1992, and at the 20th annual meeting of the International Neuropsychological Society, Galveston, TX, February 1993.

Supported in part by grants from the Public Health Service (AG09399 and NS 14867).

Received November 30,1992. Accepted for publication in final form March 4, 1993.

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