Neurocognitive Impact Of Whole Brain Radiation On Patients With Brain Metastases: Secondary Analysis Of Rtog Br-0018

Purpose/Objective(s)RTOG BR-0018 was a prospective feasibility study of neurocognitive evaluation in patients (pts) treated with whole brain radiation (WBRT) for brain metastases. The objective of this secondary analysis is to report the impact of WBRT on the neurocognitive and quality of life measures.Materials and MethodsAll pts received 37.5 Gy in 15 fractions for WBRT, and were required to undergo the following tests at baseline, end of WBRT, and 1 month (mo) follow-up (f-u): Mini-Mental State Exam (MMSE)–memory, attention, and cognition; Hopkins Verbal Learning Test (HVLT)–memory; Verbal Fluency/Controlled Word Association Test (COWAT)–executive functioning, verbal learning, working memory, and vocabulary; Ruff 2 and 7–selective attention; and Trailmaking Test A and B (TMT-A, TMT-B)–focused attention and speed performance. Quality of life was measured with the Profile of Mood States Short Form (POMS) which assesses 6 distinct and transient moods.ResultsA total of 59 pts were accrued from November 2000 to August 2001; 55 analyzable pts comprise this report. Median f-u was 56 days. Only 7% of pts had intracranial progression by 1 mo. MMSE showed improvement or stability in 53% of pts by the end of WBRT and 63% by 1 mo f-u. While 3 out of 4 subtests of HVLT declined at the end of WBRT, at 1 mo f-u 2 subtests returned to baseline levels while 2 subtests improved above the baseline. All 3 subtests of Ruff 2 and 7 declined by the end of WBRT; however, at 1 mo f-u 2 subtests improved above the baseline while 1 subtest continued to decline. Both TMT-A and TMT-B declined by end of WBRT; however, both tests showed significant improvements above the baseline by 1 mo f-u. COWAT declined by the end of WBRT; however, this returned to baseline by 1 mo f-u. The 6 moods in the POMS demonstrated an improvement or stability in 53–86% of pts by the end of WBRT, and 42–78% of pts by 1 mo f-u (table). In particular, tension was improved/remained stable in 80% of pts by end of WBRT and 68% by 1 mo f-u, while confusion was improved/remained stable in 84% and 78% of pts.ConclusionsWBRT has often been cited as the principle cause of neurocognitive decline in pts with brain metastases. However, this study demonstrates that WBRT, even in a group with expected limited survival, results in improvements in neurocognitive and quality of life measures by 1 mo post-WBRT compared to pre-WBRT. These data corroborate recent studies that indicate that brain tumor progression, independent of systemic disease progression, may have the greatest impact in neurocognitive decline in cancer pts. Purpose/Objective(s)RTOG BR-0018 was a prospective feasibility study of neurocognitive evaluation in patients (pts) treated with whole brain radiation (WBRT) for brain metastases. The objective of this secondary analysis is to report the impact of WBRT on the neurocognitive and quality of life measures. RTOG BR-0018 was a prospective feasibility study of neurocognitive evaluation in patients (pts) treated with whole brain radiation (WBRT) for brain metastases. The objective of this secondary analysis is to report the impact of WBRT on the neurocognitive and quality of life measures. Materials and MethodsAll pts received 37.5 Gy in 15 fractions for WBRT, and were required to undergo the following tests at baseline, end of WBRT, and 1 month (mo) follow-up (f-u): Mini-Mental State Exam (MMSE)–memory, attention, and cognition; Hopkins Verbal Learning Test (HVLT)–memory; Verbal Fluency/Controlled Word Association Test (COWAT)–executive functioning, verbal learning, working memory, and vocabulary; Ruff 2 and 7–selective attention; and Trailmaking Test A and B (TMT-A, TMT-B)–focused attention and speed performance. Quality of life was measured with the Profile of Mood States Short Form (POMS) which assesses 6 distinct and transient moods. All pts received 37.5 Gy in 15 fractions for WBRT, and were required to undergo the following tests at baseline, end of WBRT, and 1 month (mo) follow-up (f-u): Mini-Mental State Exam (MMSE)–memory, attention, and cognition; Hopkins Verbal Learning Test (HVLT)–memory; Verbal Fluency/Controlled Word Association Test (COWAT)–executive functioning, verbal learning, working memory, and vocabulary; Ruff 2 and 7–selective attention; and Trailmaking Test A and B (TMT-A, TMT-B)–focused attention and speed performance. Quality of life was measured with the Profile of Mood States Short Form (POMS) which assesses 6 distinct and transient moods. ResultsA total of 59 pts were accrued from November 2000 to August 2001; 55 analyzable pts comprise this report. Median f-u was 56 days. Only 7% of pts had intracranial progression by 1 mo. MMSE showed improvement or stability in 53% of pts by the end of WBRT and 63% by 1 mo f-u. While 3 out of 4 subtests of HVLT declined at the end of WBRT, at 1 mo f-u 2 subtests returned to baseline levels while 2 subtests improved above the baseline. All 3 subtests of Ruff 2 and 7 declined by the end of WBRT; however, at 1 mo f-u 2 subtests improved above the baseline while 1 subtest continued to decline. Both TMT-A and TMT-B declined by end of WBRT; however, both tests showed significant improvements above the baseline by 1 mo f-u. COWAT declined by the end of WBRT; however, this returned to baseline by 1 mo f-u. The 6 moods in the POMS demonstrated an improvement or stability in 53–86% of pts by the end of WBRT, and 42–78% of pts by 1 mo f-u (table). In particular, tension was improved/remained stable in 80% of pts by end of WBRT and 68% by 1 mo f-u, while confusion was improved/remained stable in 84% and 78% of pts. A total of 59 pts were accrued from November 2000 to August 2001; 55 analyzable pts comprise this report. Median f-u was 56 days. Only 7% of pts had intracranial progression by 1 mo. MMSE showed improvement or stability in 53% of pts by the end of WBRT and 63% by 1 mo f-u. While 3 out of 4 subtests of HVLT declined at the end of WBRT, at 1 mo f-u 2 subtests returned to baseline levels while 2 subtests improved above the baseline. All 3 subtests of Ruff 2 and 7 declined by the end of WBRT; however, at 1 mo f-u 2 subtests improved above the baseline while 1 subtest continued to decline. Both TMT-A and TMT-B declined by end of WBRT; however, both tests showed significant improvements above the baseline by 1 mo f-u. COWAT declined by the end of WBRT; however, this returned to baseline by 1 mo f-u. The 6 moods in the POMS demonstrated an improvement or stability in 53–86% of pts by the end of WBRT, and 42–78% of pts by 1 mo f-u (table). In particular, tension was improved/remained stable in 80% of pts by end of WBRT and 68% by 1 mo f-u, while confusion was improved/remained stable in 84% and 78% of pts. ConclusionsWBRT has often been cited as the principle cause of neurocognitive decline in pts with brain metastases. However, this study demonstrates that WBRT, even in a group with expected limited survival, results in improvements in neurocognitive and quality of life measures by 1 mo post-WBRT compared to pre-WBRT. These data corroborate recent studies that indicate that brain tumor progression, independent of systemic disease progression, may have the greatest impact in neurocognitive decline in cancer pts. WBRT has often been cited as the principle cause of neurocognitive decline in pts with brain metastases. However, this study demonstrates that WBRT, even in a group with expected limited survival, results in improvements in neurocognitive and quality of life measures by 1 mo post-WBRT compared to pre-WBRT. These data corroborate recent studies that indicate that brain tumor progression, independent of systemic disease progression, may have the greatest impact in neurocognitive decline in cancer pts.