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Very Late Treatment-Related Alterations in Brain Function of Breast Cancer Survivors

Published online by Cambridge University Press:  22 December 2014

Myrle M. Stouten-Kemperman ,
Michiel B. de Ruiter ,
Willem Boogerd ,
Dick J. Veltman ,
Liesbeth Reneman  and
Sanne B. Schagen
Myrle M. Stouten-Kemperman
Affiliation:
Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands Academic Medical Center, Department of Radiology, University of Amsterdam, The Netherlands
Michiel B. de Ruiter
Affiliation:
Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands Academic Medical Center, Department of Radiology, University of Amsterdam, The Netherlands
Willem Boogerd
Affiliation:
Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Department of Neuro-Oncology, Amsterdam, The Netherlands
Dick J. Veltman
Affiliation:
VU University Medical Center, Department of Anatomy and Neuroscience, Amsterdam, The Netherlands
Liesbeth Reneman
Affiliation:
Academic Medical Center, Department of Radiology, University of Amsterdam, The Netherlands
Sanne B. Schagen*
Affiliation:
Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Division of Psychosocial Research and Epidemiology, Amsterdam, The Netherlands
*
Correspondence and reprint requests to: Sanne B. Schagen, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands. E-mail: s.schagen@nki.nl
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Abstract

Although adjuvant chemotherapy (CT) for breast cancer (BC) is associated with very late side-effects on cognition and brain function, studies on adverse effects of specific treatment regimens are scarce. Here, neurotoxicity profiles after different treatment strategies were compared in BC survivors randomized to high-dose (HI) or conventional-dose (CON-) CT, in women treated with radiotherapy (RT) -only and a healthy control (HC) group. We administered a neurocognitive test battery, a planning fMRI task (Tower of London) and episodic memory fMRI task (Paired Associates paradigm) in BC survivors who received CON-CT (n=24) and HC (n=27). Data were compared to BC survivors who received HI-CT (n=17) and RT-only (n=15) and who were previously assessed. Testing took place ±11.5 years post-CT. Furthermore, neurocognitive data were compared to neurocognitive data acquired ≤2 years post-treatment. Cognitive assessment revealed sustained cognitive decline in 10.5% of HI-CT, 8.3% of CON-CT, 6.7% of RT-only patients and 0% in the HC. Hypoactivation was found in task-related prefrontal and parietal areas for both CT-groups versus RT-only, with HI-CT showing more pronounced hypoactivation than CON-CT, combined with worse task performance. RT-only survivors performed at a similar level to HC while showing hyperactivation in task-related brain areas. Long after treatment, CT is associated with cognitive problems and task-related hypoactivation that depend on the specific cytotoxic regimen. This worse performance in patients who received CT could be explained by impaired brain functioning that is more severe with more intense CT. (JINS, 2015, 21, 50–61)

Keywords

Adjuvant chemotherapyfMRIlong-termCognitionBreast cancerAdverse effects
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 21 , Supplement 1 , January 2015 , pp. 50 - 61
Copyright
Copyright © The International Neuropsychological Society 2014 

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