Concomitant treatment of brain metastases with whole brain radiotherapy and temozolomide protects neurocognitive function and improve quality of life

Abstract

Purpose: To study the protective effects of a combination of temozolomide (TMZ) and whole brain radiotherapy (WBT) on neurocognition, and its effect on the quality of life (QoL) in patients with brain metastasis (BM) from solid tumors, relative to WBT alone. Methods: A total of 256 BM patients were enrolled and divided into two groups treated with either WBT plus TMZ, or WBRT alone. All patients received 30 Gy WBT, with or without concomitant TMZ (75 mg/m 2 /day) during the irradiation period, and subsequently up to six cycles of TMZ (150 mg/m 2 /day). Results: The mean intracranial objective response (IOR) for all patients was 44.80 % while the IOR for WBT arm and WBT+TMZ group arm were 32.48 and 56.56 %, respectively (p = 0.03). The median intracranial overall survival (OS) for all the patients was 7.70 months. The median OS for WBT alone group (6.53 months) was significantly shorter than that of the WBT + TMZ arm (9.57 months). Statistically significant difference in quality of life (QoL) was observed between both arms at six months. Moreover, WBT+TMZ group had higher incidence of toxicity, when compared to WBT-only group. Conclusion: These results suggest that co-application of WBT and TMZ improves intracranial ORR and median OS in BM patients, relative to the use of WBT alone. Although the side effects may be increased as a result of addition of TMZ, toxicity is tolerable and manageable.

The Impact of Stereotactic or Whole Brain Radiotherapy on Neurocognitive Functioning in Adult Patients with Brain Metastases: A Systematic Review and Meta-Analysis

“…Similarly, patients who survived more than 6 months after HA-WBRT with simultaneous integrated boost recovered to baseline scores regarding L&M performance [41]. On the contrary, performance on most cognitive tasks declined in at least 114 patients who received conventional WBRT [35, 39, 40]. L&M performance was most often affected, with 53% of the patients showing decline [35].…”

“…L&M performance was most often affected, with 53% of the patients showing decline [35]. Moreover, the percentage of patients with declined performance increased from 19% at short-term to 35% at midterm follow-up [39]. Although group performance declined compared to both baseline and short-term follow-up when considering all 17 patients in the Onodera et al [25] cohort, improvements were observed in a subgroup of patients with a baseline BMs volume of <4.0 cm 3 and in BMs patients surviving at least 12 months [25].…”