Long-term neurocognitive and other side effects of radiotherapy, with or without chemotherapy, for glioma
Gliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low aggressive potential in the short term, i.e. low-grade gliomas. Most people with low-grade gliomas are treated with surgery and may receive radiother...
Gespeichert in:
| Veröffentlicht in: | Cochrane database of systematic reviews Jg. 8; S. CD013047 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Journal Article |
| Sprache: | Englisch |
| Veröffentlicht: |
England
05.08.2019
|
| Schlagworte: | |
| ISSN: | 1469-493X, 1469-493X |
| Online-Zugang: | Weitere Angaben |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| Abstract | Gliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low aggressive potential in the short term, i.e. low-grade gliomas. Most people with low-grade gliomas are treated with surgery and may receive radiotherapy thereafter. However, there is concern about the possible long-term effects of radiotherapy, especially on neurocognitive functioning.
To evaluate the long-term neurocognitive and other side effects of radiotherapy (with or without chemotherapy) compared with no radiotherapy, or different types of radiotherapy, among people with glioma (where 'long-term' is defined as at least two years after diagnosis); and to write a brief economic commentary.
We searched the following databases on 16 February 2018 and updated the search on 14 November 2018: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11) in the Cochrane Library; MEDLINE via Ovid; and Embase via Ovid. We also searched clinical trial registries and relevant conference proceedings from 2014 to 2018 to identify ongoing and unpublished studies.
Randomised and non-randomised trials, and controlled before-and-after studies (CBAS). Participants were aged 16 years and older with cerebral glioma other than glioblastoma. We included studies where patients in at least one treatment arm received radiotherapy, with or without chemotherapy, and where neurocognitive outcomes were assessed two or more years after treatment.
Two review authors independently extracted data and assessed risk of bias. We assessed the certainty of findings using the GRADE approach.
The review includes nine studies: seven studies were of low-grade glioma and two were of grade 3 glioma. Altogether 2406 participants were involved but there was high sample attrition and outcome data were available for a minority of people at final study assessments. In seven of the nine studies, participants were recruited to randomised controlled trials (RCTs) in which longer-term follow-up was undertaken in a subset of people that had survived without disease progression. There was moderate to high risk of bias in studies due to lack of blinding and high attrition, and in two observational studies there was high risk of selection bias. Paucity of data and risk of bias meant that evidence was of low to very low certainty. We were unable to combine results in meta-analysis due to diversity in interventions and outcomes.The studies examined the following five comparisons.Radiotherapy versus no adjuvant treatmentTwo observational studies contributed data. At the 12-year follow-up in one study, the risk of cognitive impairment (defined as cognitive disability deficits in at least five of 18 neuropsychological tests) was greater in the radiotherapy group (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.02 to 3.71; n = 65); at five to six years the difference between groups did not reach statistical significance (RR 1.38, 95% CI 0.92 to 2.06; n = 195). In the other study, one subject in the radiotherapy group had cognitive impairment (defined as significant deterioration in eight of 12 neuropsychological tests) at two years compared with none in the control group (very low certainty evidence).With regard to neurocognitive scores, in one study the radiotherapy group was reported to have had significantly worse mean scores on some tests compared with no radiotherapy; however, the raw data were only given for significant findings. In the second study, there were no clear differences in any of the various cognitive outcomes at two years (n = 31) and four years (n = 15) (very low certainty evidence).Radiotherapy versus chemotherapyOne RCT contributed data on cognitive impairment at up to three years with no clear difference between arms (RR 1.43, 95% CI 0.36 to 5.70, n = 117) (low-certainty evidence).High-dose radiotherapy versus low-dose radiotherapyOnly one of two studies reporting this comparison contributed data, and at two and five years there were no clear differences between high- and low-dose radiotherapy arms (very low certainty evidence).Conventional radiotherapy versus stereotactic conformal radiotherapyOne study involving younger people contributed limited data from the subgroup aged 16 to 25 years. The numbers of participants with neurocognitive impairment at five years after treatment were two out of 12 in the conventional arm versus none out of 11 in the stereotactic conformal radiotherapy arm (RR 4.62, 95% CI 0.25 to 86.72; n = 23; low-certainty evidence).Chemoradiotherapy versus radiotherapyTwo RCTs tested for cognitive impairment. One defined cognitive impairment as a decline of more than 3 points in MMSE score compared with baseline and reported data from 2-year (110 participants), 3-year (91 participants), and 5-year (57 participants) follow-up with no clear difference between the two arms at any time point. A second study did not report raw data but measured MMSE scores over five years in 126 participants at two years, 110 at three years, 69 at four years and 53 at five years. Authors concluded that there was no difference in MMSE scores between the two study arms (P = 0.4752) (low-certainty evidence).Two RCTs reported quality of life (QoL) outcomes for this comparison. One reported no differences in Brain-QoL scores between study arms over a 5-year follow-up period (P = 0.2767; no raw data were given and denominators were not stated). The other trial reported that the long-term results of health-related QoL showed no difference between the arms but did not give the raw data for overall HRQoL scores (low-certainty evidence).We found no comparative data on endocrine dysfunction; we planned to develop a brief economic commentary but found no relevant economic studies for inclusion.
Radiotherapy for gliomas with a good prognosis may increase the risk of neurocognitive side effects in the long term; however the magnitude of the risk is uncertain. Evidence on long-term neurocognitive side effects associated with chemoradiotherapy is also uncertain. Neurocognitive assessment should be an integral part of long-term follow-up in trials involving radiotherapy for lower-grade gliomas to improve the certainty of evidence regarding long-term neurocognitive effects. Such trials should also assess other potential long-term effects, including endocrine dysfunction, and evaluate costs and cost effectiveness. |
|---|---|
| AbstractList | Gliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low aggressive potential in the short term, i.e. low-grade gliomas. Most people with low-grade gliomas are treated with surgery and may receive radiotherapy thereafter. However, there is concern about the possible long-term effects of radiotherapy, especially on neurocognitive functioning.
To evaluate the long-term neurocognitive and other side effects of radiotherapy (with or without chemotherapy) compared with no radiotherapy, or different types of radiotherapy, among people with glioma (where 'long-term' is defined as at least two years after diagnosis); and to write a brief economic commentary.
We searched the following databases on 16 February 2018 and updated the search on 14 November 2018: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11) in the Cochrane Library; MEDLINE via Ovid; and Embase via Ovid. We also searched clinical trial registries and relevant conference proceedings from 2014 to 2018 to identify ongoing and unpublished studies.
Randomised and non-randomised trials, and controlled before-and-after studies (CBAS). Participants were aged 16 years and older with cerebral glioma other than glioblastoma. We included studies where patients in at least one treatment arm received radiotherapy, with or without chemotherapy, and where neurocognitive outcomes were assessed two or more years after treatment.
Two review authors independently extracted data and assessed risk of bias. We assessed the certainty of findings using the GRADE approach.
The review includes nine studies: seven studies were of low-grade glioma and two were of grade 3 glioma. Altogether 2406 participants were involved but there was high sample attrition and outcome data were available for a minority of people at final study assessments. In seven of the nine studies, participants were recruited to randomised controlled trials (RCTs) in which longer-term follow-up was undertaken in a subset of people that had survived without disease progression. There was moderate to high risk of bias in studies due to lack of blinding and high attrition, and in two observational studies there was high risk of selection bias. Paucity of data and risk of bias meant that evidence was of low to very low certainty. We were unable to combine results in meta-analysis due to diversity in interventions and outcomes.The studies examined the following five comparisons.Radiotherapy versus no adjuvant treatmentTwo observational studies contributed data. At the 12-year follow-up in one study, the risk of cognitive impairment (defined as cognitive disability deficits in at least five of 18 neuropsychological tests) was greater in the radiotherapy group (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.02 to 3.71; n = 65); at five to six years the difference between groups did not reach statistical significance (RR 1.38, 95% CI 0.92 to 2.06; n = 195). In the other study, one subject in the radiotherapy group had cognitive impairment (defined as significant deterioration in eight of 12 neuropsychological tests) at two years compared with none in the control group (very low certainty evidence).With regard to neurocognitive scores, in one study the radiotherapy group was reported to have had significantly worse mean scores on some tests compared with no radiotherapy; however, the raw data were only given for significant findings. In the second study, there were no clear differences in any of the various cognitive outcomes at two years (n = 31) and four years (n = 15) (very low certainty evidence).Radiotherapy versus chemotherapyOne RCT contributed data on cognitive impairment at up to three years with no clear difference between arms (RR 1.43, 95% CI 0.36 to 5.70, n = 117) (low-certainty evidence).High-dose radiotherapy versus low-dose radiotherapyOnly one of two studies reporting this comparison contributed data, and at two and five years there were no clear differences between high- and low-dose radiotherapy arms (very low certainty evidence).Conventional radiotherapy versus stereotactic conformal radiotherapyOne study involving younger people contributed limited data from the subgroup aged 16 to 25 years. The numbers of participants with neurocognitive impairment at five years after treatment were two out of 12 in the conventional arm versus none out of 11 in the stereotactic conformal radiotherapy arm (RR 4.62, 95% CI 0.25 to 86.72; n = 23; low-certainty evidence).Chemoradiotherapy versus radiotherapyTwo RCTs tested for cognitive impairment. One defined cognitive impairment as a decline of more than 3 points in MMSE score compared with baseline and reported data from 2-year (110 participants), 3-year (91 participants), and 5-year (57 participants) follow-up with no clear difference between the two arms at any time point. A second study did not report raw data but measured MMSE scores over five years in 126 participants at two years, 110 at three years, 69 at four years and 53 at five years. Authors concluded that there was no difference in MMSE scores between the two study arms (P = 0.4752) (low-certainty evidence).Two RCTs reported quality of life (QoL) outcomes for this comparison. One reported no differences in Brain-QoL scores between study arms over a 5-year follow-up period (P = 0.2767; no raw data were given and denominators were not stated). The other trial reported that the long-term results of health-related QoL showed no difference between the arms but did not give the raw data for overall HRQoL scores (low-certainty evidence).We found no comparative data on endocrine dysfunction; we planned to develop a brief economic commentary but found no relevant economic studies for inclusion.
Radiotherapy for gliomas with a good prognosis may increase the risk of neurocognitive side effects in the long term; however the magnitude of the risk is uncertain. Evidence on long-term neurocognitive side effects associated with chemoradiotherapy is also uncertain. Neurocognitive assessment should be an integral part of long-term follow-up in trials involving radiotherapy for lower-grade gliomas to improve the certainty of evidence regarding long-term neurocognitive effects. Such trials should also assess other potential long-term effects, including endocrine dysfunction, and evaluate costs and cost effectiveness. Gliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low aggressive potential in the short term, i.e. low-grade gliomas. Most people with low-grade gliomas are treated with surgery and may receive radiotherapy thereafter. However, there is concern about the possible long-term effects of radiotherapy, especially on neurocognitive functioning.BACKGROUNDGliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low aggressive potential in the short term, i.e. low-grade gliomas. Most people with low-grade gliomas are treated with surgery and may receive radiotherapy thereafter. However, there is concern about the possible long-term effects of radiotherapy, especially on neurocognitive functioning.To evaluate the long-term neurocognitive and other side effects of radiotherapy (with or without chemotherapy) compared with no radiotherapy, or different types of radiotherapy, among people with glioma (where 'long-term' is defined as at least two years after diagnosis); and to write a brief economic commentary.OBJECTIVESTo evaluate the long-term neurocognitive and other side effects of radiotherapy (with or without chemotherapy) compared with no radiotherapy, or different types of radiotherapy, among people with glioma (where 'long-term' is defined as at least two years after diagnosis); and to write a brief economic commentary.We searched the following databases on 16 February 2018 and updated the search on 14 November 2018: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11) in the Cochrane Library; MEDLINE via Ovid; and Embase via Ovid. We also searched clinical trial registries and relevant conference proceedings from 2014 to 2018 to identify ongoing and unpublished studies.SEARCH METHODSWe searched the following databases on 16 February 2018 and updated the search on 14 November 2018: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 11) in the Cochrane Library; MEDLINE via Ovid; and Embase via Ovid. We also searched clinical trial registries and relevant conference proceedings from 2014 to 2018 to identify ongoing and unpublished studies.Randomised and non-randomised trials, and controlled before-and-after studies (CBAS). Participants were aged 16 years and older with cerebral glioma other than glioblastoma. We included studies where patients in at least one treatment arm received radiotherapy, with or without chemotherapy, and where neurocognitive outcomes were assessed two or more years after treatment.SELECTION CRITERIARandomised and non-randomised trials, and controlled before-and-after studies (CBAS). Participants were aged 16 years and older with cerebral glioma other than glioblastoma. We included studies where patients in at least one treatment arm received radiotherapy, with or without chemotherapy, and where neurocognitive outcomes were assessed two or more years after treatment.Two review authors independently extracted data and assessed risk of bias. We assessed the certainty of findings using the GRADE approach.DATA COLLECTION AND ANALYSISTwo review authors independently extracted data and assessed risk of bias. We assessed the certainty of findings using the GRADE approach.The review includes nine studies: seven studies were of low-grade glioma and two were of grade 3 glioma. Altogether 2406 participants were involved but there was high sample attrition and outcome data were available for a minority of people at final study assessments. In seven of the nine studies, participants were recruited to randomised controlled trials (RCTs) in which longer-term follow-up was undertaken in a subset of people that had survived without disease progression. There was moderate to high risk of bias in studies due to lack of blinding and high attrition, and in two observational studies there was high risk of selection bias. Paucity of data and risk of bias meant that evidence was of low to very low certainty. We were unable to combine results in meta-analysis due to diversity in interventions and outcomes.The studies examined the following five comparisons.Radiotherapy versus no adjuvant treatmentTwo observational studies contributed data. At the 12-year follow-up in one study, the risk of cognitive impairment (defined as cognitive disability deficits in at least five of 18 neuropsychological tests) was greater in the radiotherapy group (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.02 to 3.71; n = 65); at five to six years the difference between groups did not reach statistical significance (RR 1.38, 95% CI 0.92 to 2.06; n = 195). In the other study, one subject in the radiotherapy group had cognitive impairment (defined as significant deterioration in eight of 12 neuropsychological tests) at two years compared with none in the control group (very low certainty evidence).With regard to neurocognitive scores, in one study the radiotherapy group was reported to have had significantly worse mean scores on some tests compared with no radiotherapy; however, the raw data were only given for significant findings. In the second study, there were no clear differences in any of the various cognitive outcomes at two years (n = 31) and four years (n = 15) (very low certainty evidence).Radiotherapy versus chemotherapyOne RCT contributed data on cognitive impairment at up to three years with no clear difference between arms (RR 1.43, 95% CI 0.36 to 5.70, n = 117) (low-certainty evidence).High-dose radiotherapy versus low-dose radiotherapyOnly one of two studies reporting this comparison contributed data, and at two and five years there were no clear differences between high- and low-dose radiotherapy arms (very low certainty evidence).Conventional radiotherapy versus stereotactic conformal radiotherapyOne study involving younger people contributed limited data from the subgroup aged 16 to 25 years. The numbers of participants with neurocognitive impairment at five years after treatment were two out of 12 in the conventional arm versus none out of 11 in the stereotactic conformal radiotherapy arm (RR 4.62, 95% CI 0.25 to 86.72; n = 23; low-certainty evidence).Chemoradiotherapy versus radiotherapyTwo RCTs tested for cognitive impairment. One defined cognitive impairment as a decline of more than 3 points in MMSE score compared with baseline and reported data from 2-year (110 participants), 3-year (91 participants), and 5-year (57 participants) follow-up with no clear difference between the two arms at any time point. A second study did not report raw data but measured MMSE scores over five years in 126 participants at two years, 110 at three years, 69 at four years and 53 at five years. Authors concluded that there was no difference in MMSE scores between the two study arms (P = 0.4752) (low-certainty evidence).Two RCTs reported quality of life (QoL) outcomes for this comparison. One reported no differences in Brain-QoL scores between study arms over a 5-year follow-up period (P = 0.2767; no raw data were given and denominators were not stated). The other trial reported that the long-term results of health-related QoL showed no difference between the arms but did not give the raw data for overall HRQoL scores (low-certainty evidence).We found no comparative data on endocrine dysfunction; we planned to develop a brief economic commentary but found no relevant economic studies for inclusion.MAIN RESULTSThe review includes nine studies: seven studies were of low-grade glioma and two were of grade 3 glioma. Altogether 2406 participants were involved but there was high sample attrition and outcome data were available for a minority of people at final study assessments. In seven of the nine studies, participants were recruited to randomised controlled trials (RCTs) in which longer-term follow-up was undertaken in a subset of people that had survived without disease progression. There was moderate to high risk of bias in studies due to lack of blinding and high attrition, and in two observational studies there was high risk of selection bias. Paucity of data and risk of bias meant that evidence was of low to very low certainty. We were unable to combine results in meta-analysis due to diversity in interventions and outcomes.The studies examined the following five comparisons.Radiotherapy versus no adjuvant treatmentTwo observational studies contributed data. At the 12-year follow-up in one study, the risk of cognitive impairment (defined as cognitive disability deficits in at least five of 18 neuropsychological tests) was greater in the radiotherapy group (risk ratio (RR) 1.95, 95% confidence interval (CI) 1.02 to 3.71; n = 65); at five to six years the difference between groups did not reach statistical significance (RR 1.38, 95% CI 0.92 to 2.06; n = 195). In the other study, one subject in the radiotherapy group had cognitive impairment (defined as significant deterioration in eight of 12 neuropsychological tests) at two years compared with none in the control group (very low certainty evidence).With regard to neurocognitive scores, in one study the radiotherapy group was reported to have had significantly worse mean scores on some tests compared with no radiotherapy; however, the raw data were only given for significant findings. In the second study, there were no clear differences in any of the various cognitive outcomes at two years (n = 31) and four years (n = 15) (very low certainty evidence).Radiotherapy versus chemotherapyOne RCT contributed data on cognitive impairment at up to three years with no clear difference between arms (RR 1.43, 95% CI 0.36 to 5.70, n = 117) (low-certainty evidence).High-dose radiotherapy versus low-dose radiotherapyOnly one of two studies reporting this comparison contributed data, and at two and five years there were no clear differences between high- and low-dose radiotherap |
| Author | Vale, Luke Erridge, Sara Lawrie, Theresa A Gillespie, David Dowswell, Therese Kernohan, Ashleigh Evans, Jonathan Grant, Robin |
| Author_xml | – sequence: 1 givenname: Theresa A surname: Lawrie fullname: Lawrie, Theresa A organization: Cochrane Gynaecological, Neuro-oncology and Orphan Cancer Group, 1st Floor Education Centre, Royal United Hospital, Combe Park, Bath, UK, BA1 3NG – sequence: 2 givenname: David surname: Gillespie fullname: Gillespie, David – sequence: 3 givenname: Therese surname: Dowswell fullname: Dowswell, Therese – sequence: 4 givenname: Jonathan surname: Evans fullname: Evans, Jonathan – sequence: 5 givenname: Sara surname: Erridge fullname: Erridge, Sara – sequence: 6 givenname: Luke surname: Vale fullname: Vale, Luke – sequence: 7 givenname: Ashleigh surname: Kernohan fullname: Kernohan, Ashleigh – sequence: 8 givenname: Robin surname: Grant fullname: Grant, Robin |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31425631$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkEtLxDAcxIOsuA_9CkuOHuyaV9PmKOsTFrwoeCtp889upG1q0ir77S3rip5m4DcMw8zRpPUtILSkZEUJYddUyJTmab5a3xLKichW3VCyEzQbgUqE4m-Tf36K5jG-E8IVpfkZmnIqWCo5nSG38e026SE0uIUh-MpvW9e7T8C6Ndj3Owg4OgMYrIWqj9hbHLRxB6K7_RX-cv0O-3BQP_S42kHzR-1ItrXzjT5Hp1bXES6OukCv93cv68dk8_zwtL7ZJJXIOEuErIwyGZGpTcFQU0phRcnKkoAxRI4jCKtMSoU2imhCtOZWgbQmJ1qmKmMLdPnT2wX_MUDsi8bFCupat-CHWDCWc6X4eMAYXR6jQ9mAKbrgGh32xe897Bt0XW0Z |
| CitedBy_id | crossref_primary_10_1016_j_radonc_2021_04_023 crossref_primary_10_1038_s41598_024_60396_w crossref_primary_10_1155_2022_8335400 crossref_primary_10_3389_fonc_2020_576701 crossref_primary_10_1007_s00432_022_04431_1 crossref_primary_10_1007_s00701_022_05339_y crossref_primary_10_3389_fpsyg_2023_1130331 crossref_primary_10_1186_s13014_022_02187_z crossref_primary_10_1007_s11060_025_05079_w crossref_primary_10_1007_s11060_024_04677_4 crossref_primary_10_3892_etm_2021_10291 crossref_primary_10_1016_j_radonc_2022_11_024 crossref_primary_10_2340_1651_226X_2025_43883 crossref_primary_10_3389_fendo_2024_1426781 crossref_primary_10_1007_s11060_024_04595_5 crossref_primary_10_1007_s11064_021_03427_6 crossref_primary_10_3390_life14111377 crossref_primary_10_1007_s11060_023_04368_6 crossref_primary_10_1088_1361_6560_ad4192 crossref_primary_10_1007_s12032_023_01951_9 crossref_primary_10_3389_fonc_2024_1368606 crossref_primary_10_3389_fped_2025_1595223 crossref_primary_10_1007_s11060_025_05006_z crossref_primary_10_1016_j_radonc_2020_11_004 crossref_primary_10_3389_fonc_2024_1445558 crossref_primary_10_1002_pro6_70020 crossref_primary_10_3389_fnhum_2020_571191 crossref_primary_10_1016_j_radonc_2020_03_023 crossref_primary_10_1007_s40291_021_00537_3 crossref_primary_10_1007_s15015_023_3200_8 crossref_primary_10_1016_j_phro_2021_11_008 crossref_primary_10_1038_s41598_024_63716_2 crossref_primary_10_1080_01616412_2024_2354620 crossref_primary_10_1016_j_colsurfb_2025_115059 crossref_primary_10_1007_s11912_020_01006_6 |
| ContentType | Journal Article |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1002/14651858.CD013047.pub2 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 1469-493X |
| ExternalDocumentID | 31425631 |
| Genre | Research Support, Non-U.S. Gov't Systematic Review Journal Article |
| GrantInformation_xml | – fundername: Department of Health grantid: SRP/16/114/18 – fundername: Medical Research Council grantid: MR/K02325X/1 |
| GroupedDBID | --- 53G 5GY 7PX 9HA ABJNI ACGFO ACGFS AENEX ALMA_UNASSIGNED_HOLDINGS ALUQN AYR CGR CUY CVF D7G ECM EIF HYE NPM OEC OK1 P2P RWY WOW ZYTZH 7X8 |
| ID | FETCH-LOGICAL-c4732-46cd9d7065f5ed1db64f4b2bb0edd06fec02cd514ad90a00aa3f9e6fd80a65972 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 109 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000484777900027&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 1469-493X |
| IngestDate | Wed Oct 01 14:09:43 EDT 2025 Sat May 31 02:11:04 EDT 2025 |
| IsDoiOpenAccess | false |
| IsOpenAccess | true |
| IsPeerReviewed | true |
| IsScholarly | true |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-c4732-46cd9d7065f5ed1db64f4b2bb0edd06fec02cd514ad90a00aa3f9e6fd80a65972 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 |
| OpenAccessLink | https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013047.pub2/pdf/full |
| PMID | 31425631 |
| PQID | 2283993425 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_2283993425 pubmed_primary_31425631 |
| PublicationCentury | 2000 |
| PublicationDate | 2019-08-05 |
| PublicationDateYYYYMMDD | 2019-08-05 |
| PublicationDate_xml | – month: 08 year: 2019 text: 2019-08-05 day: 05 |
| PublicationDecade | 2010 |
| PublicationPlace | England |
| PublicationPlace_xml | – name: England |
| PublicationTitle | Cochrane database of systematic reviews |
| PublicationTitleAlternate | Cochrane Database Syst Rev |
| PublicationYear | 2019 |
| SSID | ssj0039118 |
| Score | 2.5904555 |
| SecondaryResourceType | review_article |
| Snippet | Gliomas are brain tumours arising from glial cells with an annual incidence of 4 to 11 people per 100,000. In this review we focus on gliomas with low... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | CD013047 |
| SubjectTerms | Antineoplastic Agents - adverse effects Antineoplastic Agents - therapeutic use Cognition Disorders - chemically induced Cognition Disorders - epidemiology Glioma - therapy Humans Radiation Injuries - complications Radiosurgery Radiotherapy - adverse effects Radiotherapy - methods Randomized Controlled Trials as Topic |
| Title | Long-term neurocognitive and other side effects of radiotherapy, with or without chemotherapy, for glioma |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/31425631 https://www.proquest.com/docview/2283993425 |
| Volume | 8 |
| WOSCitedRecordID | wos000484777900027&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV1bS8MwFA7qRHzxfpk3IvhoXNqklzyJqMOHbexBpW8jTZpRcO3cRfDfe5J225Mg-NJCQ2mbnJzz9dw-hG64lmBGmHUvBZxwYwQRxnCiVcylb4JIOYfbeyfq9eIkEf3a4Tat0yoXOtEpal0q6yNv2TYtYEtBxO7Hn8SyRtnoak2hsY4aDKCMTemKkmUUgcFGjqvqIsukxpJFhTD1W57lAI-D-O7xycbueGQ_3_8dZjpz097974vuoZ0aaOKHSjL20VpWHKCtbh1KP0R5pyyGxCpm7HpaLvOIsCw0dnVZ2FJ54jrjA5cGT6TO64qt71tsXbi4nLhzOZ9hWP7RahTAMB5-5OVIHqG39vPr4wupeReI4hHzCQ-VFtrGP02QaU-nITc89dOUZlrTEB5KfaUBaUktqKRUSmZEFhodUxnCD4p_jDaKsshOETYwHGjhS6NTLpUSSpk49gyXDESEp010vZjEAci1DVbIIivn08FqGpvopFqJwbhqwDFgHlwOmXf2h7vP0TZgHOFy9oIL1DCwq7NLtKm-Zvl0cuUEBo69fvcHox3Mww |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Long-term+neurocognitive+and+other+side+effects+of+radiotherapy%2C+with+or+without+chemotherapy%2C+for+glioma&rft.jtitle=Cochrane+database+of+systematic+reviews&rft.au=Lawrie%2C+Theresa+A&rft.au=Gillespie%2C+David&rft.au=Dowswell%2C+Therese&rft.au=Evans%2C+Jonathan&rft.date=2019-08-05&rft.issn=1469-493X&rft.eissn=1469-493X&rft.volume=8&rft.spage=CD013047&rft_id=info:doi/10.1002%2F14651858.CD013047.pub2&rft.externalDBID=NO_FULL_TEXT |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=1469-493X&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=1469-493X&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=1469-493X&client=summon |