Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study

Habets, Esther J. J.; Dirven, Linda; Wiggenraad, Ruud; Kanter, Antoinette Verbeek-de; Nijeholt, Geert J. Lycklama à; Zwinkels, Hanneke; Klein, Martin; Taphoorn, Martin J.B.

doi:10.1093/neuonc/nov186

Cited by 96 publications

(137 citation statements)

References 41 publications

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“…OS, overall survival; EGFR, epidermal growth factor receptor; ALK, anaplastic lymphoma kinase; SRS, safety of stereotactic radiosurgery; WBRT, whole brain radiotherapy; CI, confidence interval. SRS generally has advantages when compared with WBRT in terms of safety, such as the late development of cognitive dysfunction and alopecia, which could affect patients' quality of life (20)(21)(22)(23)(24)(25). Yamamoto et al reported the safety and feasibility of SRS for ten or more BMs when compared to the patients with less lesions (11) In addition SRS can be applied repeatedly for BMs and can be performed in a shorter time, resulting in a reduced burden on patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison between stereotactic radiosurgery and whole‑brain radiotherapy for 10‑20 brain metastases from non‑small cell lung cancer

et al. 2019

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The efficacy and safety of stereotactic radiosurgery (SRS) in comparison with whole brain radiotherapy (WBRT) for brain metastases (BMs) remains unclear. The present study retrospectively reviewed 44 patients who received SRS or WBRT as an initial treatment for 10-20 BMs from non-small cell lung cancer between 2009 and 2016. Of the patients, 24 (54.5%) were treated with SRS and 20 (45.5%) were treated with WBRT. Overall survival (OS), time to intracranial progression (TTIP), neurological survival (NS), and prognostic factors were examined. OS did not significantly differ between the two groups: 7.3 months in the SRS group vs. 7.2 months in the WBRT group (P= 0.502). Median TTIP was significantly shorter in the SRS group than in the WBRT group (7.1 vs. 19.1 months, P= 0.009). In contrast, there were no significant differences in NS between the two groups (14.5 months in the SRS group vs. 12.9 months in the WBRT group, P= 0.346). Univariate and multivariate analysis revealed that the type of initial treatment for BMs (WBRT or SRS) was not a significant prognostic factor (hazard ratio= 0.80, 95% confidence interval: 0.42-1.52, P= 0.502). However, histology, performance status, subsequent molecular targeted drugs, subsequent chemotherapy and salvage treatment were independent prognostic factors. There were no significant differences in OS and NS between treatment with SRS and treatment with WBRT in patients with 10-20 BMs, although TTIP was improved with WBRT. As an upfront treatment for 10-20 BMs, SRS may delay WBRT and the adverse events associated with WBRT.

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Section: Discussionmentioning

confidence: 99%

Comparison between stereotactic radiosurgery and whole‑brain radiotherapy for 10‑20 brain metastases from non‑small cell lung cancer

et al. 2019

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“…Baseline characteristics of patients with baseline HRQoL scores were not reported in two studies [39,40]. For two studies [33,36], a proportion of patients was also included in a subsequent study (respectively [32,37]). Sample sizes in the 9 selected studies ranged from 15 to 97 patients.…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

“…In most studies, patients were female (range 43.2 to 67.3%), had primary lung cancer (range 37.3 to 100%), and had a median Karnofsky Performance Status (KPS) score of 80 (range < 70 to 100) ( Table 1). In four studies [34][35][36][37], patients with newly diagnosed BM were included; in four other studies [32,33,38,39], patients received prior BM treatment; and in one study [40], it was not reported if patients received prior BM treatment. Reasons for dropout were not reported in 6 studies [32,34,35,[38][39][40], and in two studies [36,37], reasons of dropout were reported, but without the numbers of patients (Table 1).…”

Section: Characteristics Of Studiesmentioning

confidence: 99%

Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review

Verhaak

Gehring

Hanssens

et al. 2019

Support Care Cancer

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Purpose A growing number of patients with brain metastases (BM) are being treated with stereotactic radiosurgery (SRS), and the importance of evaluating the impact of SRS on the health-related quality of life (HRQoL) in these patients has been increasingly acknowledged. This systematic review summarizes the current knowledge about the HRQoL of patients with BM after SRS. Methods We searched EMBASE, Medline Ovid, Web-of-Science, the Cochrane Database, PsycINFO Ovid, and Google Scholar up to November 15, 2018. Studies in patients with BM in which HRQoL was assessed before and after SRS and analyzed over time were included. Studies including populations of several types of brain cancer and/or several types of treatments were included if the results for patients with BM and treatment with SRS alone were described separately. Results Out of 3638 published articles, 9 studies met the eligibility criteria and were included. In 4 out of 7 studies on group results, overall HRQoL of patients with BM remained stable after SRS. In small study samples of longer-term survivors, overall HRQoL remained stable up to 12 months post-SRS. Contradictory results were reported for physical and general/global HRQoL, which might be explained by the different questionnaires that were used. Conclusions In general, SRS does not have significant negative effects on patients' overall HRQoL over time. Future research is needed to analyze different aspects of HRQoL, differences in individual changes in HRQoL after SRS, and factors that influence these changes. These studies should take into account several methodological issues as discussed in this review.

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“…Whole body irradiation [23], whole brain irradiation with low [24] or high LET rays [25] and stereotactic radiosurgery [26] have all been shown to be able to induce cognitive dysfunction in rodents. Nonetheless, WBI with X-ray or γ-ray is the main modality to treat brain tumors in current clinical practice.…”

Section: Irradiation Dose In Cognitive Testsmentioning

confidence: 99%

The Current Utilization of Cognitive Tests in the Research of Radiation-Induced Cognitive Dysfunction in Rodent Models

Li¹,

Chen²,

Zhang³

2017

Brain Disord Ther

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Recent clinical studies suggest that radiation-induced damage to the hippocampus plays a considerable role in the cognitive dysfunction of patients after cranial irradiation. In particular, deficits in learning, memory, and spatial processing observed in patients who received WBI are thought to be related to hippocampal injury [7]. The mechanisms of radiation-induced cognitive dysfunction are not yet fully understood. According to the available knowledge, radiation-induced cognitive dysfunction is hypothesized to result from dynamic interactions between multiple cell types: vascular and glial clonogens, neurogenesis, neural function and neuroinflammation [8][9][10]. Therefore, studies into the mechanisms and preventive measures of radiation-induced cognitive dysfunction are of paramount importance to decrease the side effects of WBI and increase the quality of life of patients. To achieve this goal, widely acknowledged animal models and universally utilized cognitive tests are the prerequisite and foundation. The Establishment of Rodent ModelsRodents, including mice and rats, are the most commonly utilized animal models in medical research given their genetic background, anatomical structure, operability, and relatively low cost of use [11]. Experimental data indicated that rodents showed similar anatomical AbstractWhole brain irradiation using low LET rays has remained the mainstay to treat some primary and metastatic brain tumors. Radiation-induced cognitive dysfunction is a progressive and irreversible late side effect after whole brain irradiation and inevitably decreases the quality of life of cancer survivors. To address this negative issue, many studies have been performed to explore the mechanisms of radiation-induced cognitive dysfunction and to develop efficacious preventive and treating measures. The prerequisite and foundation of implementing a persuasive and profound study to investigate radiation-induced cognitive dysfunction is the utilization of widely acknowledged animal models and universally applied cognitive tests. In this review, articles studying radiation-induced cognitive dysfunction from 2011 to 2016 were collected. The establishment of animal models and detailed utilization of cognitive tests were analyzed and summarized. This review summarized the general range of irradiation doses and time intervals utilized and the effects of these two factors on the results of cognitive tests. changes and physiopathological mechanisms to human beings after cranial irradiation [12]. In addition, the effects of radiation on rodents could be assessed over relatively short time periods-weeks to months rather than years to decades. Anatomical and functional changes of rodents after cranial irradiation are dependent on age, dose, and sex, which are compatible with the risk factors in human patients [13]. Given that these observations are representative of the effects seen in patients, the rodent model would enable the efficient study of mechanisms and treatments.

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Neurocognitive functioning and health-related quality of life in patients treated with stereotactic radiotherapy for brain metastases: a prospective study

Cited by 96 publications

References 41 publications

Comparison between stereotactic radiosurgery and whole‑brain radiotherapy for 10‑20 brain metastases from non‑small cell lung cancer

Comparison between stereotactic radiosurgery and whole‑brain radiotherapy for 10‑20 brain metastases from non‑small cell lung cancer

Health-related quality of life in adult patients with brain metastases after stereotactic radiosurgery: a systematic, narrative review

The Current Utilization of Cognitive Tests in the Research of Radiation-Induced Cognitive Dysfunction in Rodent Models

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