Neurocognitive function assessment for cancer patients with brain metastases following whole brain radiation therapy: a single institutional ob- servational study from a tertiary care hospital

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.

Methods: 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 assessments using Mi- ni-Mental State Examination (MMSE) were conducted before and at the 2nd, 3rd, and 6th months post-WBRT.

Results: The study, encompassing a median age of 58, revealed that 43.3% had lung primary and 35% breast primary. The mean MMSE score was 27 pre-radiation. Fol- lowing WBRT, a more than equal to 3-point MMSE decrease occurred in 6.6%, 11.6%, and 18.3% at the 2nd, 3rd, and 6th months post-radiation respectively. Neurocogni- tive decline was 36% for those above 50 years and 64% for those below 50 years by the 6th month. In 2nd month 88.3% of 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 in 3rd and 6th month observations.

Conclusion: WBRT is crucial for local control of brain metastases, but neurocog- nitive decline, especially under 50, is of major concern. Study results offer aware- ness for pre-treatment counseling on WBRT benefits, risks, and consideration for Hippocampal Avoidance of WBRT or WBRT with memantine, and requires further extensive research