title: Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study.
abstract: BACKGROUND
  Stereotactic radiotherapy (SRT) is expected to have a less detrimental effect on neurocognitive functioning and health-related quality of life (HRQoL) than whole-brain radiotherapy. To evaluate the impact of brain metastases and SRT on neurocognitive functioning and HRQoL, we performed a prospective study.
  
  
  METHODS
  Neurocognitive functioning and HRQoL of 97 patients with brain metastases were measured before SRT and 1, 3, and 6 months after SRT. Seven cognitive domains were assessed. HRQoL was assessed with the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 and BN20 questionnaires. Neurocognitive functioning and HRQoL over time were analyzed with linear mixed models and stratified for baseline Karnofsky performance status (KPS), total metastatic volume, and systemic disease.
  
  
  RESULTS
  Median overall survival of patients was 7.7 months. Before SRT, neurocognitive domain and HRQoL scores were lower in patients than in healthy controls. At group level, patients worsened in physical functioning and fatigue at 6 months, while other outcome parameters of HRQoL and cognition remained stable. KPS < 90 and tumor volume >12.6 cm(3) were both associated with worse information processing speed and lower HRQoL scores over 6 months time. Intracranial tumor progression was associated with worsening of executive functioning and motor function.
  
  
  CONCLUSIONS
  Prior to SRT, neurocognitive functioning and HRQoL are moderately impaired in patients with brain metastases. Lower baseline KPS and larger tumor volume are associated with worse functioning. Over time, SRT does not have an additional detrimental effect on neurocognitive functioning and HRQoL, suggesting that SRT may be preferred over whole-brain radiotherapy.
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
authors.forename: Esther J J
authors.initials: EJ
authors.lastname: Habets
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
authors.forename: Linda
authors.initials: L
authors.lastname: Dirven
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
authors.forename: Ruud G
authors.initials: RG
authors.lastname: Wiggenraad
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
authors.forename: Antoinette
authors.initials: A
authors.lastname: Verbeek-de Kanter
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
authors.forename: Geert J
authors.initials: GJ
authors.lastname: Lycklama À Nijeholt
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
authors.forename: Hanneke
authors.initials: H
authors.lastname: Zwinkels
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
authors.forename: Martin
authors.initials: M
authors.lastname: Klein
authors.affiliation: Department of Neurology, Medical Center Haaglanden, The Hague, the Netherlands (E.J.J.H., H.Z., M.J.B.T.); Department of Neurology, VU University Medical Center, Amsterdam, the Netherlands (L.D., M.J.B.T.); Radiotherapy Center West, The Hague, the Netherlands (R.G.W., A.V.-d.K.); Department of Radiology, Medical Center Haaglanden, The Hague, the Netherlands (G.J.L.àN.); Department of Medical Psychology, VU University Medical Center, Amsterdam, the Netherlands (M.K.).
authors.forename: Martin J B
authors.initials: MJ
authors.lastname: Taphoorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000532:radiotherapy*; D003071:Cognition / Q000502:physiology*; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D011795:Surveys and Questionnaires
keywords: brain metastases; cognition; health-related quality of life; stereotactic radiotherapy