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Medientyp:
E-Artikel
Titel:
Improvement in neurocognitive function (NCF) correlates with tumor regression after whole brain radiation therapy (WBRT) for brain metastases (BM)
Beteiligte:
Li, J.;
Bentzen, S. M.;
Renschler, M.;
Mehta, M. P.
Erschienen:
American Society of Clinical Oncology (ASCO), 2006
Beschreibung:
<jats:p> 1504 </jats:p><jats:p> Background: Few prospective trials have explored the neurocognitive impact of WBRT in BM patients (pts), complicated by competing effects between benefit from WBRT and deterioration due to disease progression. Methods: 208 pts from the WBRT alone arm (30 Gy) of a phase III trial (PCYC-9801) evaluating motexafin gadolinium in BM were analyzed. NCF was assessed by 8 tests of memory, executive function and fine motor coordination, and correlated to BM volume change by MRI, using Spearman’s rank correlation. Pts with tumor shrinkage below and above the median (45%) were compared for survival and NCF deterioration using Kaplan-Meier analysis. Results: 135 pts (65%) were evaluable for BM volume at baseline and 2 months (mo). Pts were divided into “good” and “poor” responders based on % volume reduction at 2 mo above or below the population median of 45%. The uni-directional hypothesis of improved survival in good responders was significant (P = 0.03, median survival (MS) 300±26 days (d) vs 240±19 d). For all 8 tests, the median time to NCF deterioration was longer in good responders than in poor responders. Largest gains were for an executive function test Trailmaking B (131 d gain, P=0.02), fine motor tests Pegboard non-dominant hand (110 d gain, P=0.05) and Pegboard dominant hand (93 d gain, P=0.02). In 15 mo survivors, statistically significant correlation between tumor shrinkage and NCF preservation was seen for 4/8 NCF tests (r = 0.68–0.88), especially for executive function and fine motor coordination. At early follow-up, the population mean NCF scores were dominated by pts with progressive disease, as reflected by a sharp drop in the mean NCF scores at 4 mo. 15-mo survivors had stable or improving scores, associated with greater reduction in BM volume in the 15 versus 4 mo survivors. Conclusions: WBRT-induced tumor shrinkage correlates with better survival and NCF preservation. NCF is stable or improved in long-term BM survivors. The adverse impact of tumor growth on neurocognitive function appears greater than that of WBRT. </jats:p><jats:p> [Table: see text] </jats:p>