Neurocognition and quality of life in patients with intracranial metastases – contributing factors and impact on clinical outcome

Abstract

Abstract Cognitive impairment at diagnosis is prevalent in patients with brain metastases (BM). Neurocognitive function (NCF) decline following radiotherapy is well described in this patient cohort, but the impact of baseline NCF on clinical outcome and survival is less well understood. In this study we describe NCF in patients at baseline before undergoing stereotactic radiosurgery without whole brain radiotherapy and explore its impact on overall survival and explore possible causative factors. Baseline NCF data was collected in patients with 1–3 BM and WHO performance status 0–2. Patients underwent NCF assessments according to the RANO group and included Hopkin’s verbal learning test, controlled oral word association test, trail making test A and B and digit span. We collected quality of life (QoL) data using EORTC QLQ30/BN20 questionnaires and recorded functional assessment of cancer therapy scores. 31 patients underwent neurocognitive testing with mean age of 65 years and median overall survival was 10 months. 21 patients had a single metastasis. The most common primary site was lung (12) followed by melanoma (7). 64% of patients exhibited impaired NCF at baseline in at least 1 domain with a Z-score of >1 and this was associated with lower overall survival. Other factors associated with lower overall survival were presence of seizures, steroid use and larger tumour volume. In this study impaired NCF at baseline was associated with lower overall survival. Intracranial disease burden and the presence of seizures were also associated with worse NCF and worse survival indicating that these may be important causative factors to consider.