Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone.
OBJECTIVE
To determine how the omission of whole brain radiotherapy (WBRT) affects the neurocognitive function of patients with one to four brain metastases who have been treated with stereotactic radiosurgery (SRS).


METHODS
In a prospective randomized trial between WBRT+SRS and SRS alone for patients with one to four brain metastases, we assessed the neurocognitive function using the Mini-Mental State Examination (MMSE). Of the 132 enrolled patients, MMSE scores were available for 110.


RESULTS
In the baseline MMSE analyses, statistically significant differences were observed for total tumor volume, extent of tumor edema, age, and Karnofsky performance status. Of the 92 patients who underwent the follow-up MMSE, 39 had a baseline MMSE score of < or =27 (17 in the WBRT+SRS group and 22 in the SRS-alone group). Improvements of > or =3 points in the MMSEs of 9 WBRT+SRS patients and 11 SRS-alone patients (p = 0.85) were observed. Of the 82 patients with a baseline MMSE score of > or =27 or whose baseline MMSE score was < or =26 but had improved to > or =27 after the initial brain treatment, the 12-, 24-, and 36-month actuarial free rate of the 3-point drop in the MMSE was 76.1%, 68.5%, and 14.7% in the WBRT+SRS group and 59.3%, 51.9%, and 51.9% in the SRS-alone group, respectively. The average duration until deterioration was 16.5 months in the WBRT+SRS group and 7.6 months in the SRS-alone group (p = 0.05).


CONCLUSIONS
The results of the present study have revealed that, for most brain metastatic patients, control of the brain tumor is the most important factor for stabilizing neurocognitive function. However, the long-term adverse effects of WBRT on neurocognitive function might not be negligible.
Department of Radiology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. hao@radi.med.hokudai.ac.jp
Hidefumi
H
Aoyama
Masao
M
Tago
Norio
N
Kato
Tatsuya
T
Toyoda
Masahiro
M
Kenjyo
Saeko
S
Hirota
Hiroki
H
Shioura
Taisuke
T
Inomata
Etsuo
E
Kunieda
Kazushige
K
Hayakawa
Keiichi
K
Nakagawa
Gen
G
Kobashi
Hiroki
H
Shirato
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000523:psychology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D003071:Cognition / Q000528:radiation effects*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D007564:Japan; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D011446:Prospective Studies; D016634:Radiosurgery / Q000379:methods*