Abstract
PurposeInformation on predictive factors of cognitive functioning in patients with (multiple) brain metastases (BM) selected for radiosurgery may allow for more individual care and may play a role in predicting cognitive outcome after radiosurgery. The aim of this study was to evaluate cognitive performance, and predictors thereof, in patients with 1–10 BM before radiosurgery.MethodsCognition was measured before radiosurgery using a standardized neuropsychological test battery in patients with 1–10 BM (expected survival > 3 months; KPS ≥ 70; no prior BM treatment). Regression formulae were constructed to calculate sociodemographically corrected z scores. Group and individual cognitive functioning was analyzed. Multivariable regression was used to explore potential predictors.ResultsPatients (N = 92) performed significantly worse than controls (N = 104) on all 11 test variables (medium-large effect sizes for 8 variables). Percentages of impairment were highest for information processing (55.3%), dexterity (43.2%) and cognitive flexibility (28.7%). 62% and 46% of patients had impairments in at least two, or three test variables, respectively. Models including combinations of clinical and psychological variables were predictive of verbal memory, psychomotor speed, information processing and dexterity. Neither number nor volume of metastases predicted patients’ test performance.ConclusionsAlready before radiosurgery, almost half of the patients suffered from severe cognitive deficits in at least three test variables. At group and individual level, information processing, cognitive flexibility, and dexterity were most affected. These cognitive impairments may impair daily functioning and patients’ ability to make (shared) treatment decisions. Both clinical (symptomatic BM; timing of BM diagnosis) and psychological (mental fatigue) characteristics influenced cognitive performance.Clinical trial informationCognition and Radiation Study A (CAR-Study A; ClinicalTrials.gov Identifier: NCT02953756; Medical Ethics Committee file number: NL53472.028.15/P1515).
Highlights
Stereotactic radiosurgery (SRS) is increasingly applied in patients with brain metastases (BM) as it is expected to cause less cognitive damage than whole brain radiation therapy (WBRT) because it allows precise radiation delivery to the BM only
This study showed that total volume of BM was a predictor for baseline cognitive impairment in patients that were randomly assigned to WBRT with or without motexafin gadolinium
In this study we examined the incidence and severity of cognitive impairment, and clinical as well as psychological predictors thereof, in selected patients with 1–10 BM who were accepted for GKRS
Summary
Stereotactic radiosurgery (SRS) is increasingly applied in patients with brain metastases (BM) as it is expected to cause less cognitive damage than whole brain radiation therapy (WBRT) because it allows precise radiation delivery to the BM only. Before BM treatment, many patients experience cognitive impairments that may be caused by several factors, including the BM itself, medication use, the primary cancer, or side effects. There have been relatively few studies in patients with newly diagnosed BM who undergo SRS that evaluated (baseline) cognitive functions with objective neuropsychological tests, as opposed to insensitive measures for this purpose such as the Mini-Mental Status Examination (MMSE) [5]. Far, only a few studies have examined the relationship between number and volume of BM and (pretreatment) cognitive functioning in patients with BM. This study showed that total volume of BM was a predictor for baseline cognitive impairment in patients that were randomly assigned to WBRT with or without motexafin gadolinium
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