Beyond Oncologic Outcome: - Utility Of Cognitive Outcome Assessent In Supratentorial Gliomas.

Abstract

Background: Gliomas are among the commonest primary brain tumors. Despite significant advances in molecular diagnosis and elucidation of pathogenesis, the prognosis remains guarded. Surgical resection is limited by lack of a clearly defined brain-tumor interface due to tumoral infiltration beyond the radiologically defined boundaries. Methodology: - A literature review on outcomes in Gliomas. Objective: Discuss the utility of cognitive assessment in determination of functional outcome. Results: Traditionally, outcome following glioma surgery has been determined using oncologic parameters such as extent of resection, progression free survival and overall survival. These parameters are an incomplete representation of the patient status. Functional outcome is a composite that includes; Activities of daily living, neurologic outcome, cognitive outcome, Seizure outcome, and HRQOL (Health related quality of life). Oncofunctional balance is the bridge between the traditional and functional outcome measures. Cognitive outcome is key determinant of functional outcome. This paper discusses the utility of the Addenbrooke Cognitive Assessment III as a simple, yet sensitive tool for routine clinical use. The importance of pre and post operative assessment in determining cognitive outcome is also discussed. Conclusion: Cognitive outcome is useful in the determination of tumor progression, response to treatment, palliative care goals and prognostication.