Cognitive function testing in adult brain tumor trials: lessons from a comprehensive review

Abstract

Neurocognitive function (NCF) impairment is an important component of primary and metastatic brain tumors and their therapeutic interventions. As a result, modern clinical trials of cranial irradiation for adult cancer patients have incorporated NCF testing as a primary or secondary end point. In doing so, these clinical trials have provided a novel insight into our understanding of the NCF effects of cranial irradiation and brain tumor progression. In this article, we review these clinical trials both in terms of the trial findings and in terms of the types of NCF tests used in these trials. We also provide an introduction to the strengths and limitations of these NCF tests, as well as expert commentary on the current status and future directions of NCF testing in brain tumor trials.

Keywords::

• brain tumors
• cranial irradiation
• Hopkins Verbal Learning Test
• Mini-Mental Status Exam
• neurocognitive function
• Stroop test
• Trail Making Tests
• whole-brain radiotherapy

Financial & competing interests disclosure

C Caine is the Neuropsychology co-chair for RTOG 0925 and RTOG 0933. NN Laack is co-principal investigator for RTOG 0925. MP Mehta and V Gondi are co-principal investigators for RTOG 0933. C Caine, MP Mehta and V Gondi receive research funding from the National Cancer Institute to pilot a software-based approach to neurocognitive function testing in RTOG 0933. MP Mehta has or has had the following roles in the last 2 years (2010–2011): consultant for: Adnexus, Bayer, Merck, Roche and Tomotherapy; stock options in Colby, Pharmacyclics, Procertus, Stemina and Tomotherapy; been on the data safety monitoring boards for Apogenix; been on the board of directors for Pharmacyclics; been on the Medical Advisory Boards for Colby, Stemina and Procertus; Speaker for Merck. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.