Evaluation of mini-mental status examination score obtained after using gamma knife radiosurgery as the initial radiation treatment for brain metastasesKeywords: brain metastasis, Neuropsychological Testing, gamma knife, outcome, surveyInteractive ManuscriptAsk Questions of this Manuscript: What is the background behind your study?Cognitive function is important in brain metastasis management. What is the purpose of your study?This study aimed to evaluate (1) the mini-mental status examination scores (MMSEs) of patients with brain metastases, after they underwent gamma knife radiosurgery (GKS) without whole-brain radiation treatment (WBRT) and (2) the factors influencing MMSEs. Describe your patient group.We could evaluate 76 patients (63.9%) after GKS. The median age, number of brain metastases, and total volume of brain metastases were 65.5 years (range, 40–92 years), 2 (range, 1–18), and 4.17 ml (range, 0.04–27.0 ml), respectively. Describe what you did.Between January 2009 and June 2011, all patients with new brain metastases, i.e., 119 patients, were treated using 1 session of GKS without WBRT as initial radiation therapy. MMSEs were determined for all patients before GKS and for the surviving patients at every 3 months after GKS. Describe your main findings. The median values for marginal dose, total skull integral dose, and MMSE follow-up time were 22.0 Gy (range, 14–24 Gy), 2.9 joules (range, 0.1–9.6 joules), and 5.8 months (range, 0.9–21.6 months), respectively.Thirty-nine patients (51.3%) developed new distant lesions after the first GKS. The median survival time with or without follow-up MMSEs was 8.8 and 2.8 months, respectively. The median pre-GKS MMSE in cases where follow-up MMSEs were obtained was 28 (range, 3–30). Thirty-eight patients (50.0%) had a pre-GKS MMSE of <27. The follow-up MMSEs of 16 patients (42.1%) improved by >3 points and those of 15 patients (19.7%) deteriorated by >3 points. For 4 of these 15 patients, the cause of deterioration was not directly related with brain metastases; for 4 of the remaining 11 patients, the deterioration in MMSEs recovered to within 3 points. The 6- and 12-month actual free rates of the 3-point drop in the MMSEs were 83.9% (47 of 56 cases) and 79.2% (19 of 24 cases), respectively. Larger tumor volume was associated with an improvement of >3 points in the follow-up MMSE. No risk factors were significantly associated with a deterioration of >3 points in the follow-up MMSEs. Describe the main limitation of this study.The data was collected prospectively. The main limitation was that we did not perform a comprehensive neuropsychological test battery. Describe your main conclusion.GKS stabilizes neurocognitive function with less adverse effects. Describe the importance of your findings and how they can be used by others.The mental deterioration of patients with large symptomatic metastatic tumors tends to decrease after GKS. Cognitive function is important in brain metastasis management. This study aimed to evaluate (1) the mini-mental status examination scores (MMSEs) of patients with brain metastases, after they underwent gamma knife radiosurgery (GKS) without whole-brain radiation treatment (WBRT) and (2) the factors influencing MMSEs. We could evaluate 76 patients (63.9%) after GKS. The median age, number of brain metastases, and total volume of brain metastases were 65.5 years (range, 40–92 years), 2 (range, 1–18), and 4.17 ml (range, 0.04–27.0 ml), respectively. Between January 2009 and June 2011, all patients with new brain metastases, i.e., 119 patients, were treated using 1 session of GKS without WBRT as initial radiation therapy. MMSEs were determined for all patients before GKS and for the surviving patients at every 3 months after GKS. The median values for marginal dose, total skull integral dose, and MMSE follow-up time were 22.0 Gy (range, 14–24 Gy), 2.9 joules (range, 0.1–9.6 joules), and 5.8 months (range, 0.9–21.6 months), respectively.Thirty-nine patients (51.3%) developed new distant lesions after the first GKS. The median survival time with or without follow-up MMSEs was 8.8 and 2.8 months, respectively. The median pre-GKS MMSE in cases where follow-up MMSEs were obtained was 28 (range, 3–30). Thirty-eight patients (50.0%) had a pre-GKS MMSE of <27. The follow-up MMSEs of 16 patients (42.1%) improved by >3 points and those of 15 patients (19.7%) deteriorated by >3 points. For 4 of these 15 patients, the cause of deterioration was not directly related with brain metastases; for 4 of the remaining 11 patients, the deterioration in MMSEs recovered to within 3 points. The 6- and 12-month actual free rates of the 3-point drop in the MMSEs were 83.9% (47 of 56 cases) and 79.2% (19 of 24 cases), respectively. Larger tumor volume was associated with an improvement of >3 points in the follow-up MMSE. No risk factors were significantly associated with a deterioration of >3 points in the follow-up MMSEs. The data was collected prospectively. The main limitation was that we did not perform a comprehensive neuropsychological test battery. GKS stabilizes neurocognitive function with less adverse effects. The mental deterioration of patients with large symptomatic metastatic tumors tends to decrease after GKS. Project Roles:
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