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BACKGROUND Our previous study among 195 low-grade glioma (LGG) patients six years after initial diagnosis, showed that high radiation doses (&gt;2 Gy) were associated with neurocognitive disability. Follow-up at 12 years in 64 LGG patients showed patients without radiotherapy to have stable neurocognitive and radiological status while attentional functioning deteriorated between 6 and 12 years in irradiated patients. The present assessment at a mean of 26 years after initial diagnosis and treatment, investigates the neurocognitive sequelae of radiotherapy in long-term survivors. METHODS Patients who were alive since the 12 year follow-up were invited for assessment of the same neurocognitive domains as tested at 6 and 12 years: attention, executive functioning, verbal memory, working memory, psychomotor functioning, and information processing speed. Using a mixed model, standardized scores of neurocognitive performance were compared between treatment (radiotherapy versus no radiotherapy) and over time. FINDINGS: 32 patients, of whom 13 (41%) had received radiotherapy, completed the assessment at a mean of 26 years (range 20–35 years) after initial diagnosis. Patients who had radiotherapy had more attentional deficits at the present assessment, than those who did not (–1·0 [SD 1·6] vs 0·33 [0·65], p=0·01; mean difference 1·3, 95% CI 0·3–2·3). Furthermore, patients who had radiotherapy had reduced attentional functioning over time (p=0·03), regardless of antiepileptic drug use. Three (23%) patients who had radiotherapy developed neurocognitive disabilities deficits in at least four of the 20 neuropsychological test parameters compared with five (26%) patients who did not have radiotherapy. INTERPRETATION: Extreme long-term, and probably surviving LGG patients who had radiotherapy show relatively stable and adequate neurocognitive functioning when compared to patients who did not have radiotherapy. Apart from attentional functioning, no progression of neurocognitive deficits at 26 years after initial diagnosis were found.

NCOG-07. COGNITIVE SEQUELAE OF RADIOTHERAPY IN LOW-GRADE GLIOMA PATIENTS 26 YEARS AFTER INITIAL DIAGNOSIS: FINAL REPORT