Evaluation of mini-mental status examination score obtained after using gamma knife radiosurgery as the initial radiation treatment for brain metastases

Keywords: brain metastasis, Neuropsychological Testing, gamma knife, outcome, survey

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     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.


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