Dose-Volume Effects of Partial-Brain Radiation Therapy on Late Neurocognitive Processing Speed and Executive Function

125 Background: Use of whole brain radiation, radiosurgery, targeted therapies, and more recently, immunotherapies have resulted in improved survival for patients with brain metastases. As patients live longer, it is becoming increasingly important to understand the long-term cognitive function (CF) and quality of life (QOL) changes associated with these therapies. Methods: The Yale Gamma Knife Database was searched for patients surviving greater than 2 years after brain metastasis diagnosis. Of 79 patients identified, 19 were willing to participate in study. All participants underwent a single assessment session of cognitive tests that evaluated executive function (TMTa and TMTb), processing speed (COWA), memory (HVLT), and quality of life (FACT-Br). Results: Within the whole group, mean age was 65.5 years (range 50-88), median time from brain metastasis diagnosis to testing was 60 months (range 25.6-120.6). Mean number of lesions treated was 3.8 (range 1-10). Mean total lesion volume treated was 14.1 mm3 (range 0.6 - 39). Only 2 patients were treated with whole brain radiation therapy. Patient scores were compared to validated normative data for their age group. Patients performed worse than normal for their age on TMTb (p < 0.0001), total word recall (p < 0.0001) and discriminative ability (p = 0.0004). Patients performed as expected for age on TMTa, animal naming, FAS, and % retention. A negative correlation was seen between executive function results and QOL (TMTa: r = -0.569, p ≤ 0.05, TMTb: r = -0.484, p ≤ 0.05) and a positive correlation was seen between processing speed results and QOL (r = 0.672, p ≤ 0.001). Conclusions: In patients surviving more than 2 years after diagnosis and successful treatment of brain metastases, this study shows that portions of executive function and memory are worse than expected for their age, while cognitive processing speed is similar to norms. Cognitive function was correlated with QOL; patients with lowered cognitive function reported a lower quality of life. Given this preliminary data, a further study in a larger population is needed to determine if certain treatments preferentially predispose patients to declines in CF and QOL.

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Dosimetric Predictors of Cognitive Decline in Attention and Processing Speed after Fractionated Brain Radiation Therapy

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.038 ◽

2018 ◽

Vol 102 (3) ◽

pp. S171 ◽

Cited By ~ 1

Author(s):

M.P. Huynh-Le ◽

K.R. Tringale ◽

R. Karunamuni ◽

D.C. Marshall ◽

J. Burkeen ◽

...

Keyword(s):

Radiation Therapy ◽

Cognitive Decline ◽

Processing Speed ◽

Brain Radiation

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Dose-volume effects of breast cancer radiation therapy on the risk of second oesophageal cancer

Radiotherapy and Oncology ◽

10.1016/j.radonc.2020.07.022 ◽

2020 ◽

Vol 151 ◽

pp. 33-39

Author(s):

Neige Journy ◽

Sara J. Schonfeld ◽

Michael Hauptmann ◽

Sander Roberti ◽

Rebecca M. Howell ◽

...

Keyword(s):

Breast Cancer ◽

Radiation Therapy ◽

Oesophageal Cancer ◽

Dose Volume ◽

Volume Effects

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Prospective Neurobehavioral Functions in Newly-diagnosed Patients With Primary CNS Lymphoma Treated With Hyperfractionated Conformal Whole-brain Radiation Therapy Plus Simultaneous Integrated Boost

Case Medical Research ◽

10.31525/ct1-nct04006561 ◽

2019 ◽

Author(s):

Keyword(s):

Radiation Therapy ◽

Primary Cns Lymphoma ◽

Simultaneous Integrated Boost ◽

Whole Brain Radiation Therapy ◽

Cns Lymphoma ◽

Newly Diagnosed ◽

Whole Brain ◽

Whole Brain Radiation ◽

Integrated Boost ◽

Brain Radiation

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Gamma knife treatment for multiple metastatic brain tumors compared with whole-brain radiation therapy

Journal of Neurosurgery ◽

10.3171/jns.2000.93.supplement_3.0032 ◽

2000 ◽

Vol 93 (supplement_3) ◽

pp. 32-36 ◽

Cited By ~ 57

Author(s):

Toru Serizawa ◽

Toshihiko Iuchi ◽

Junichi Ono ◽

Naokatsu Saeki ◽

Katsunobu Osato ◽

...

Keyword(s):

Radiation Therapy ◽

Gamma Knife ◽

Gamma Knife Radiosurgery ◽

Cerebral Metastases ◽

Whole Brain Radiation Therapy ◽

Whole Brain ◽

Content Type ◽

Whole Brain Radiation ◽

Brain Radiation ◽

Fine Print

Object. The purpose of this retrospective study was to compare the effectiveness of gamma knife radiosurgery (GKS) for multiple cerebral metastases with that of whole-brain radiation therapy (WBRT). Methods. Ninety-six consecutive patients with cerebral metastases from nonsmall cell lung cancer were treated between 1990 and 1999. The entry criteria were the presence of between one and 10 multiple brain lesions at initial diagnosis, no surgically inaccessible tumors with more than a 30-mm diameter, no carcinomatous meningitis, and more than 2 months of life expectancy. The patients were divided into two groups: the GKS group (62 patients) and the WBRT group (34 patients). In the GKS group, large lesions (> 30 mm) were removed surgically and all other small lesions (≤ 30 mm) were treated by GKS. New distant lesions were treated by repeated GKS without prophylactic WBRT. In the WBRT group, the patients were treated by the traditional combined therapy of WBRT and surgery. In both groups, chemotherapy was administered according to the primary physician's protocol. The two groups did not differ in terms of age, sex, initial Karnofsky Performance Scale (KPS) score, type, lesion number, and size of lesion, systemic control, and chemotherapy. Neurological survival and qualitative survival of the GKS group were longer than those of the WBRT group. In multivariate analysis, significant poor prognostic factors were systemically uncontrolled patients, WBRT group, and poor initial KPS score. Conclusions. Gamma knife radiosurgery without prophylactic WBRT could be a primary choice of treatment for patients with as many as 10 cerebral metastases from nonsmall cell cancer.

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