title: Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial.
abstract: Intraoperative permanent Cesium-131 (Cs-131) brachytherapy can provide a viable alternative to WBRT with excellent response rates and minimal toxicity. This study reports the results of the prospective trial of the impact of intraoperative Cs-131 on neurocognitive function and quality of life (QoL) in patients with resected brain metastases. Between 2010 and 2012, 24 patients with newly diagnosed metastasis to the brain were accrued on a prospective protocol and treated with Cs-131 brachytherapy seeds after surgical resection. Physicians administered the mini-mental status examination (MMSE) and functional assessment of cancer therapy-brain (FACT-Br) questionnaire to all patients before treatment and again every 2 months for the duration of 6 months with additional follow-up again at 12 months. Wilcoxon rank sum test was used to analyze statistically significant changes in MMSE over time and paired t test was used to analyze changes in FACT-BR. There was a statistical improvement in overall FACT-BR score at 4 and 6 months of follow-up when compared to baseline (162 vs. 143, P = 0.004; 164 vs. 143, P = 0.005 respectively) with a non-significant trend toward improvement at 2 and 12 months (154 vs. 143, P = 0.067; 159 vs. 149, P = 0.4). MMSE score was statistically improved at 4 and up to 12 months compared to pre-treatment MMSE (30 vs. 29, P = 0.017; 30 vs. 29, P = 0.001 respectively). Patients with brain metastasis who received intra-operative permanent Cs-131 brachytherapy implants saw an improvement of their neurocognitive status and self-assessment of QoL. In addition to the excellent local control of metastasis, this approach may contribute to the improvements in cognitive function and QOL.
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Anthony
authors.initials: A
authors.lastname: Pham
authors.affiliation: New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA.|Department of Radiation Oncology, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street at York Avenue, New York, NY, 10065, USA.
authors.forename: Menachem Z
authors.initials: MZ
authors.lastname: Yondorf
authors.affiliation: New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA.|Department of Radiation Oncology, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street at York Avenue, New York, NY, 10065, USA.
authors.forename: Bhupesh
authors.initials: B
authors.lastname: Parashar
authors.affiliation: Department of Medical Oncology, Brain and Spine Center, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street, Starr 651, Box 99, New York, NY, 10065, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Scheff
authors.affiliation: Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street, Starr 651, Box 99, New York, NY, 10065, USA.
authors.forename: Susan C
authors.initials: SC
authors.lastname: Pannullo
authors.affiliation: Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street, Starr 651, Box 99, New York, NY, 10065, USA.
authors.forename: Rohan
authors.initials: R
authors.lastname: Ramakrishna
authors.affiliation: Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street, Starr 651, Box 99, New York, NY, 10065, USA.
authors.forename: Philip E
authors.initials: PE
authors.lastname: Stieg
authors.affiliation: Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street, Starr 651, Box 99, New York, NY, 10065, USA.|Department of Otorhinolaryngology, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 1305 York Avenue, 5th Floor, New York, NY, 10065, USA.|Department of Neuroscience, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 520 E. 70th Street (at York Avenue), Starr Pavilion 607, New York, NY, 10065, USA.
authors.forename: Theodore H
authors.initials: TH
authors.lastname: Schwartz
authors.affiliation: New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA. gaw9008@med.cornell.edu.|Department of Radiation Oncology, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street at York Avenue, New York, NY, 10065, USA. gaw9008@med.cornell.edu.|Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street, Starr 651, Box 99, New York, NY, 10065, USA. gaw9008@med.cornell.edu.|Stich Radiation Oncology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY, 10065, USA. gaw9008@med.cornell.edu.
authors.forename: A Gabriella
authors.initials: AG
authors.lastname: Wernicke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D002588:Cesium Radioisotopes / Q000627:therapeutic use*; D003071:Cognition / Q000502:physiology*; D016371:Cranial Irradiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D015996:Survival Rate
chemical_list: D002588:Cesium Radioisotopes
keywords: Brachytherapy; Cesium-131 (Cs-131); Cognitive function; Metastases; Quality of life; Radiation; Radiotherapy