Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment

Tallet, Agnès; Azria, D.; Barlési, Fabrice; Spano, Jean‐Philippe; Carpentier, Antoine F.; Gonçalves, A; Métellus, Philippe

doi:10.1186/1748-717x-7-77

Cited by 179 publications

(100 citation statements)

References 41 publications

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“…The main advantage of this treatment protocol is the avoidance of the long-term cognitive sequelae associated with WBRT while maintaining a similar efficacy for disease control. 1,4,29,35,40 Although the majority of patients in our study did eventually have intracranial tumor progression, it most commonly occurred between 1 and 2 years posttreatment, suggesting that surgery plus SRS provides adequate early control of intracranial disease. This is particularly relevant given that the median survival in our study was 13 months, suggesting that most patients were deceased prior to the time period in which intracranial progression was most likely to occur.…”

Section: Discussionmentioning

confidence: 99%

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Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study

Smith¹,

Lall²,

Lall³

et al. 2014

JNS

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Object Patients with systemic cancer and a single brain metastasis who undergo treatment with resection plus radiotherapy live longer and have a better quality of life than those treated with radiotherapy alone. Historically, whole-brain radiotherapy (WBRT) has been the mainstay of radiation therapy; however, it is associated with significant delayed neurocognitive sequelae. In this study, the authors looked at survival in patients with single and multiple intracranial metastases who had undergone surgery and adjuvant stereotactic radiosurgery (SRS) to the tumor bed and synchronous lesions. Methods The authors retrospectively reviewed the records from an 8-year period at a single institution for consecutive patients with brain metastases treated via complete resection of dominant lesions and adjuvant radiosurgery. The cohort was analyzed for time to local progression, synchronous lesion progression, new intracranial lesion development, systemic progression, and overall survival. The Kaplan-Meier method (stratified by age, sex, tumor histology, and number of intracranial lesions prior to surgery) was used to calculate both progression-free and overall survival. A Cox proportional-hazards regression model was also fitted with the number of intracranial lesions as the predictor and survival as the outcome controlling for disease severity, age, sex, and primary histology. Results The median overall follow-up among the 150-person cohort eligible for analysis was 17 months. Patients had an average age of 46.2 years (range 16–82 years), and 62.7% were female. The mean (± standard deviation) number of intracranial lesions per patient was 2.5 ± 2.3. The mean time between surgery and stereotactic radiosurgery (SRS) was 3.2 ± 4.1 weeks. Primary cancers included lung cancer (43.3%), breast cancer (21.3%), melanoma (10.0%), renal cell carcinoma (6.7%), and colon cancer (6.7%). The average number of isocenters per treated lesion was 7.6 ± 6.6, and the average treatment dose was 17.8 ± 2.8 Gy. One-year survival for patients in this cohort was 52%, and the 1-year local control rate was 77%. The median (±standard error) overall survival was 13.2 ± 1.9 months. There was no difference in survival between patients with a single lesion and those with multiple lesions (p = 0.319) after controlling for age, sex, and histology of primary tumor. Patients with primary breast histology had the greatest overall median survival (22.9 ± 6.2 months); patients with colorectal cancer had the shortest overall median survival (5.3 ± 1.8 months). The most common cause of death in this series was systemic progression (79%). Conclusions These results confirm that 1-year survival for patients with multiple intracranial metastases treated with resection followed by SRS to both the tumor bed and synchronous lesions is similar to established outcomes for patients with a single intracranial metastasis.

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Section: Discussionmentioning

confidence: 99%

“…1,4,27,29,40 Additionally, brain metastases are particularly well suited for radiosurgery given that these lesions tend to have clear margins. 13 When used as a primary treatment for solitary metastasis, radiosurgery has been associated with local tumor control rates of 73%-94% and less morbidity than WBRT.…”

mentioning

confidence: 99%

Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study

Smith¹,

Lall²,

Lall³

et al. 2014

JNS

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“…Although the palliative effects of WBRT have been well documented, the risks of cognitive decline and dementia have become more prominent as medical advances extend survival. 8,33 Recent publications have indicated that WBRT has no survival benefit, no improvement in functional independence, and a negative impact on quality of life. 5,16,26,32 In our study, the survival from the time of SRS was shorter by longer than 2 months in the WBRT-treated group.…”

Section: Discussion Survivalmentioning

confidence: 99%

Gamma Knife radiosurgery for the management of cerebral metastases from non–small cell lung cancer

Bowden

Kano

Caparosa

et al. 2015

JNS

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L ung cancer is the most common malignancy in the world, accounting for 13% of all documented cancer cases, of which 85% are non-small cell lung cancer (NSCLC). NSCLC is often diagnosed at an advanced stage, as 56% of patients present with distant metastases. 31The 5-year survival for NSCLC is 19.3% overall but decreases to 4.1% with distant metastases. 15Intracranial metastases occur in an estimated 30%-40% of patients with NSCLC and are often identifiable at the time of primary diagnosis. 6,18,23 The presence of intracranial metastases is invariably associated with a decrease in median survival across all cancer types. 10 The median survival for a patient with NSCLC and intracranial metastases who forgoes treatment is reportedly less than 2 months. The addition of fractionated whole-brain radiation therapy (WBRT) increases survival to only 3-6 months. 4,6 Gamma Knife radiosurgery (GKRS) has proven to be a low risk and effective treatment strategy for a wide variety of patients with brain metastases. The local tumor control after SRS in NSCLC patients consistently exceeds 80% in the literature. 24,30 The utilization of SRS for NSCLC metastases has increased significantly and appropriately abbreviatioNs GKRS = Gamma Knife radiosurgery; KPS = Karnofsky Performance Scale; NSCLC = non-small cell lung cancer; RPA = recursive partitioning analysis; RTOG = Radiation Therapy Oncology Group; SRS = stereotactic radiosurgery; WBRT = whole-brain radiotherapy. obJect Non-small cell lung cancer (NSCLC) is the most frequent cancer that metastasizes to brain. Stereotactic radiosurgery (SRS) has become the management of choice for most patients with such metastatic tumors. Therefore, the authors endeavored to elucidate the survival and SRS outcomes for patients with NSCLC metastasis at their center. methods In this single-institution retrospective analysis, the authors reviewed their experience with NSCLC metastasis during a 10-year period from 2001 to 2010. Seven hundred twenty patients underwent Gamma Knife radiosurgery. A total of 1004 SRS procedures were performed, and 3143 tumors were treated. The NSCLC subtype was adenocarcinoma in 386 patients, squamous cell carcinoma in 111 patients, and large cell carcinoma in 34 patients. The median aggregate tumor volume was 4.5 cm 3 (range 0.1-88 cm 3 ). results The median survival time after diagnosis of brain metastasis from NSCLC was 12.6 months, and the median survival after SRS was 8.5 months. The 1-, 2-, and 5-year survival rates after SRS were 39%, 21%, and 10%, respectively. Postradiosurgery survival was decreased in patients treated with prior whole-brain radiation therapy compared with SRS alone (p = 0.003). Aggregate tumor volume was inversely related to survival after SRS (p < 0.001), and the histological subgroups demonstrated significant survival differences (p = 0.023). The overall local tumor control rate in the entire group was 92.8%. One hundred seventy-four patients (24%) underwent repeat SRS for new or resistant metastatic deposits. coNclusioNs Stereotactic radio...

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“…However, modern studies appear to be moving towards the FACT-Br as well as the MD Anderson Symptom Inventory for Brain Tumors (MDASI-BT), as these domains are more relevant for patients with brain metastases 29 . Also prior data has suggested that MMSE is relatively insensitive in patients with brain metastases 30 . Furthermore, reporting bias could be present in the study from obtaining patients who were well enough to respond to surveys 12 months after treatment.…”

Section: Discussionmentioning

confidence: 99%

Impact of Radiosurgical Management of Geriatric Patients With Brain Metastases: Clinical and Quality of Life Outcomes

Randolph

Peiffer

Klepin

et al. 2013

International Journal of Radiation Oncology*Biology*Physics

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Neurocognitive function impairment after whole brain radiotherapy for brain metastases: actual assessment

Cited by 179 publications

References 41 publications

Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study

Survival after surgery and stereotactic radiosurgery for patients with multiple intracranial metastases: results of a single-center retrospective study

Gamma Knife radiosurgery for the management of cerebral metastases from non–small cell lung cancer

Impact of Radiosurgical Management of Geriatric Patients With Brain Metastases: Clinical and Quality of Life Outcomes

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