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Neurocognitive evaluation of brain metastases patients treated with post-resection stereotactic radiosurgery: a prospective single arm clinical trial

  • Assaf Berger
  • Ido Strauss
  • Shlomit Ben Moshe
  • Benjamin W. Corn
  • Dror Limon
  • Nathan Shtraus
  • Tal Shahar
  • Andrew A. Kanner
Clinical Study

Abstract

Purpose

Post-operative radiation therapy for brain metastases (BM) has become standard treatment. Concerns regarding the deleterious cognitive effects of Whole Brain Radiation Therapy spurred a trend to use focal therapies such as stereotactic radiosurgery (SRS). The purpose of this study was to prospectively evaluate the neuropsychological effects following post-resection SRS treatment since limited data exist in this context.

Methods

We conducted a prospective single arm cohort study of patients with 1–2 BM, who underwent resection of a single BM between May 2015 to December 2016. Patients were evaluated for cognitive functions (NeuroTrax computerized neuropsychological battery; Modiin, Israel) and quality of life (QOL; QLQ-30, QLQ-BN20) before and 3 months following post-resection SRS.

Results

Twelve out of 14 patients completed pre- and post-SRS neurocognitive assessments. Overall, we did not detect significant neurocognitive or QOL changes 3 months following SRS. In a subgroup analysis among patients younger than 60 years, median global cognitive score increased from a pre-treatment score of 88 (72–102) to 95 (79–108), 3 months following SRS treatment, p = 0.042; Wilcoxon paired non-parametric test. Immediate verbal memory and executive functions scores increased from 86 (72–98) to 98 (92–112) and 86 (60–101) to 100 (80–126), respectively, p = 0.043. No significant cognitive changes were discovered among patients at the age of 60 or older.

Conclusions

Post-resection radiosurgery has a safe neuro-cognitive profile and is associated with preservation of nearly all quality of life parameters. Patients younger than 60 years benefit most and may even regain some cognitive functions within a few months after treatment.

Keywords

Brain metastases Stereotactic radiosurgery Cognition Quality of life 

Notes

Compliance with ethical standards

Conflict of interest

the authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryTel Aviv Medical CenterTel AvivIsrael
  2. 2.Stereotactic Radiosurgery UnitTel Aviv Medical CenterTel AvivIsrael
  3. 3.Institute of RadiotherapyTel Aviv Medical CenterTel AvivIsrael
  4. 4.Department of NeurosurgeryShaare Zedek Medical CenterJerusalemIsrael
  5. 5.Department of Neurosurgery and Stereotactic Radiosurgery UnitRabin Medical CenterPetah TikvaIsrael
  6. 6.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael

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