Mini-mental Status: The Potential Effects On Test Scores Related To Multiple Gamma Knife Stereotactic Radiosurgery Treatments For Brain Metastases

Maitz A.H.1, I.S. Grills1, S. Macina1, M. Manders1, E. Ducharme1, Rick Olson1, J. Fontanesi1, D. Krauss1, D. Pieper1, P. Chen1

1William Beaumont Hospital, Royal Oak, USA

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

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     The purpose of this study was to investigate differences in total brain volume, brain volume irradiated, treated tumor volumes as related to mini-mental status.
     From January 2007 through October 2009, of 53 patients treated 2 or more times with GKSRS for brain metastases, whole brain external beam radiation therapy was administered to 20. Of original 53 patients 22 had pre GK total brain volumes quantified and mini-mental status assessment performed (7 WBXRT recipients). Of the 53 patients treated 2 times, 15 were treated 3 times, 2 were treated 4 times and 1 was treated 5 times.
     The total brain volumes were assessed based on the CT and MRI scans acquired each time the patient was treated as well as the total volume treated including any external whole brain radiation administered. All volumetric assessments were performed using the tools provided by the Leksell Gamma Plan Version 4C. A standard mini mental status test was administered prior to treatment as a baseline followed by subsequent assessments prior to each GKSRS.
     Total brain volumes ranged from 1060 to 1750 cc (median: 1393.6 cc). Patients receiving whole brain external beam radiation comprised 38% of the patients (18 before GKSRS, 2 between GKSRS1 and GKSRS2, 2 between GKSRS2 and GKSRS3). The median mini mental baseline score was 29.8 (range: 28-30). The score medians for third, fourth and fifth treatments were 29.7, 28.6, and 30 respectively. These scores were further stratified by the addition of whole brain and compared to the total brain volumes and total brain dose at each interval.
     This is a retrospective study.
     There was no statistical difference in mini-mental status between the groups of GKSRS alone and GKSRS + WBXRT regardless of the number of GKSRS treatments, the order in which the treatments occurred or the timing of the subsequent treatments. 
     An interesting aspect was the difference between the GKSRS alone versus GKSRS + WBXRT on survival which was, upon inspection, longer for the GKSRS alone but not statistically significant.


Project Roles:

M. A.H. (), I. Grills (), S. Macina (), M. Manders (), E. Ducharme (), R. Olson (), J. Fontanesi (), D. Krauss (), D. Pieper (), P. Chen ()