Gamma Knife Center, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
Department of Neurosurgery, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands.
Neurosurgery. 2021 Apr 15;88(5):E396-E405. doi: 10.1093/neuros/nyaa586.
Survival rates have improved in the past years for patients with brain metastases (BMs).
To evaluate cognitive functioning and health-related quality of life (HRQoL) after Gamma Knife radiosurgery (GKRS) in a relatively large sample of long-term survivors.
Data from 38 long-term survivors (assessments available ≥ 12 mo post-GKRS) with, at time of enrollment, 1 to 10 newly diagnosed BMs, expected survival > 3 mo, and Karnofsky Performance Status ≥ 70 were analyzed. Cognitive functioning and HRQoL were assessed pre-GKRS (n = 38) and at 3 (n = 38), 6 (n = 37), 9 (n = 37), 12 (n = 34), 15 (n = 28), and 21 (n = 21) mo post-GKRS. The course of cognitive test performance and of HRQoL over time was analyzed using linear mixed models. Individual changes in cognitive performance and HRQoL from pre-GKRS to 21 mo were determined using reliable change indexes (RCIs) and clinical meaningful cutoffs, respectively.
Cognitive performances and HRQoL of long-term survivors remained stable or improved up to 21 mo after GKRS. Improvements were found for immediate and delayed verbal memory, working memory, information processing speed, and emotional well-being. On the individual level, most patients had stable or improved test performances or HRQoL. For physical well-being only, most patients (47.6%) showed a decline (vs 28.6% improvement or 23.8% no change) from pre-GKRS until 21 mo post-GKRS.
Up to 21 mo after GKRS, cognitive functioning and overall HRQoL improved or remained stable in long-term survivors. In long-term survivors with 1 to 10 BMs, GKRS did not cause (additional) cognitive deteriorations or declines in HRQoL at longer-term follow-up.
近年来，脑转移瘤（BMs）患者的生存率有所提高。
在一组相对较大的长期幸存者样本中，评估伽玛刀放射外科（GKRS）治疗后的认知功能和健康相关生活质量（HRQoL）。
分析了 38 名长期幸存者的数据（GKRS 后可评估时间≥12 个月），他们在入组时患有 1 至 10 个新诊断的 BMs，预计生存时间>3 个月，卡诺夫斯基表现状态≥70。在 GKRS 治疗前（n=38）和 3 个月（n=38）、6 个月（n=37）、9 个月（n=37）、12 个月（n=34）、15 个月（n=28）和 21 个月（n=21）时，评估了认知功能和 HRQoL。使用线性混合模型分析了认知测试表现和随时间的 HRQoL 变化。使用可靠变化指数（RCIs）和临床有意义的截止值，分别确定了从 GKRS 前到 21 个月时认知表现和 HRQoL 的个体变化。
GKRS 后长达 21 个月，长期幸存者的认知表现和 HRQoL 保持稳定或改善。发现即时和延迟言语记忆、工作记忆、信息处理速度和情绪健康方面有所改善。在个体水平上，大多数患者的测试表现或 HRQoL 稳定或改善。只有身体状况方面，大多数患者（47.6%）从 GKRS 前到 21 个月时出现下降（28.6%的改善或 23.8%无变化）。
在 GKRS 后长达 21 个月，长期幸存者的认知功能和整体 HRQoL 有所改善或保持稳定。在 1 至 10 个 BMs 的长期幸存者中，GKRS 在更长时间的随访中没有导致（额外）认知恶化或 HRQoL 下降。
