title: Incidence of brain atrophy and decline in mini-mental state examination score after whole-brain radiotherapy in patients with brain metastases: a prospective study.
abstract: OBJECTIVE
  To determine the incidence of brain atrophy and dementia after whole-brain radiotherapy (WBRT) in patients with brain metastases not undergoing surgery.
  
  
  METHODS
  Eligible patients underwent WBRT to 40 Gy in 20 fractions with or without a 10-Gy boost. Brain magnetic resonance imaging or computed tomography and Mini-Mental State Examination (MMSE) were performed before and soon after radiotherapy, every 3 months for 18 months, and every 6 months thereafter. Brain atrophy was evaluated by change in cerebrospinal fluid-cranial ratio (CCR), and the atrophy index was defined as postradiation CCR divided by preradiation CCR.
  
  
  RESULTS
  Of 101 patients (median age, 62 years) entering the study, 92 completed WBRT, and 45, 25, and 10 patients were assessable at 6, 12, and 18 months, respectively. Mean atrophy index was 1.24 +/- 0.39 (SD) at 6 months and 1.32 +/- 0.40 at 12 months, and 18% and 28% of the patients had an increase in the atrophy index by 30% or greater, respectively. No apparent decrease in mean MMSE score was observed after WBRT. Individually, MMSE scores decreased by four or more points in 11% at 6 months, 12% at 12 months, and 0% at 18 months. However, about half the decrease in MMSE scores was associated with a decrease in performance status caused by systemic disease progression.
  
  
  CONCLUSIONS
  Brain atrophy developed in up to 30% of patients, but it was not necessarily accompanied by MMSE score decrease. Dementia after WBRT unaccompanied by tumor recurrence was infrequent.
authors.affiliation: Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan. yshiba@med.nagoya-cu.ac.jp
authors.forename: Yuta
authors.initials: Y
authors.lastname: Shibamoto
authors.forename: Fumiya
authors.initials: F
authors.lastname: Baba
authors.forename: Kyota
authors.initials: K
authors.lastname: Oda
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayashi
authors.forename: Masaki
authors.initials: M
authors.lastname: Kokubo
authors.forename: Shun-Ichi
authors.initials: S
authors.lastname: Ishihara
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Itoh
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ogino
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koizumi
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy; D001921:Brain / Q000473:pathology* / Q000528:radiation effects; D001932:Brain Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000517:prevention & control; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016896:Treatment Outcome