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 the lack of a clearly defined brain-tumour interface due to tumoral infiltration beyond the radiologically defined boundaries. Objective: Discuss the utility of cognitive assessment in the determination of functional outcomes. Methodology: - A literature review on outcomes in Gliomas. Results: Traditionally, the outcome following glioma surgery has been determined using oncologic parameters such as the extent of resection, progression-free survival and overall survival. These parameters are an incomplete representation of the patient's 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. The cognitive outcome is a key determinant of functional outcome. This paper discusses the utility of the Addenbrooke Cognitive Assessment III as a simple, yet a sensitive tool for routine clinical use. The importance of pre and post-operative assessment in determining the cognitive outcome is also discussed.  Conclusion: Cognitive outcome is useful in the determination of tumour progression, response to treatment, palliative care goals and prognostication.