Neurocognitive function assessment for cancer patients with brain metastases following whole brain radiation therapy

Abstract

ABSTRACT BACKGROUND: Whole Brain Radiation Therapy (WBRT) has been effective in the management of brain metastases, giving good local control but has shown to have potential neurocognitive effects. Assessing its effect on neurocognitive function is decisive assessing quality of life and therapeutic decision-making. METHOD: This is an observational study at R. G. Kar Medical College and Hospital from May 2022 to April 2023 involving 60 biopsy proven carcinoma patients with brain metastases fulfilling inclusion and exclusion criteria. All received 30Gray (Gy)/10# WBRT over 2 weeks. Neurocognitive function assessment using Mini Mental State Examination (MMSE) were conducted before and at 2nd, 3rd, and 6th months post WBRT. RESULTS: The study, encompassing a median age of 58, revealed 43.3% had lung primary and 35% breast primary. Mean MMSE score was 27 pre radiation. Following WBRT, a more than equals to 3-point MMSE decrease occurred in 6.6%, 11.6%, and 18.3% at 2nd, 3rd, and 6th months post radiation respectively. Neurocognitive decline was 36% for those above 50 years and 64% for those below 50 years by the 6th month. At 2nd months 88.3% patients had controlled disease having a decrease in MMSE score by 1.6, while 11.6% with uncontrolled disease showed 3.1 MMSE change and the same trend continued at 3rd and 6th month observations. CONCLUSION: WBRT is crucial for local control of brain metastases, but neurocognitive decline, especially under 50, is of major concern. Study results offers awareness for pre-treatment counseling on WBRT benefits, risks and consideration for Hippocampal Avoidance WBRT or WBRT with memantine, and requires further extensive research.

Keywords

• Cranial Irradiation
• Brain Neoplasms
• Radiotherapy
• Cognition.