Memory function before and after whole brain radiotherapy in patients with and without brain metastases.
OBJECTIVE
To prospectively compare the effect of prophylactic and therapeutic whole brain radiotherapy (WBRT) on memory function in patients with and without brain metastases.


METHODS
Adult patients with and without brain metastases (n = 44) were prospectively evaluated with serial cognitive testing, before RT (T0), after starting RT (T1), at the end of RT (T2), and 6-8 weeks (T3) after RT completion. Data were obtained from small-cell lung cancer patients treated with prophylactic cranial irradiation, patients with brain metastases treated with therapeutic cranial irradiation (TCI), and breast cancer patients treated with RT to the breast.


RESULTS
Before therapy, prophylactic cranial irradiation patients performed worse than TCI patients or than controls on most test scores. During and after WBRT, verbal memory function was influenced by pretreatment cognitive status (p < 0.001) and to a lesser extent by WBRT. Acute (T1) radiation effects on verbal memory function were only observed in TCI patients (p = 0.031). Subacute (T3) radiation effects on verbal memory function were observed in both TCI and prophylactic cranial irradiation patients (p = 0.006). These effects were more pronounced in patients with above-average performance at baseline. Visual memory and attention were not influenced by WBRT.


CONCLUSIONS
The results of our study have shown that WBRT causes cognitive dysfunction immediately after the beginning of RT in patients with brain metastases only. At 6-8 weeks after the end of WBRT, cognitive dysfunction was seen in patients with and without brain metastases. Because cognitive dysfunction after WBRT is restricted to verbal memory, patients should not avoid WBRT because of a fear of neurocognitive side effects.
Welzel
Grit
G
Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
Fleckenstein
Katharina
K
Schaefer
Jörg
J
Hermann
Brigitte
B
Kraus-Tiefenbacher
Uta
U
Mai
Sabine K
SK
Wenz
Frederik
F
D001932:Brain Neoplasms / Q000473:pathology / Q000523:psychology / Q000532:radiotherapy* / Q000556:secondary; D002986:Clinical Trials as Topic; D003037:Cobalt Radioisotopes / Q000191:economics / Q000627:therapeutic use; D003365:Costs and Cost Analysis; D006801:Humans; D008568:Memory / Q000528:radiation effects*; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D061766:Proton Therapy; D011878:Radiotherapy / Q000009:adverse effects* / Q000191:economics; D014481:United States
D003037:Cobalt Radioisotopes