Deepsikha Goyel, Maji Tapas, Lahiri Debarshi, Roy Sanjoy, Bhanja Sayoni, Rangineni Sreekrishna, Ray Dilip Kumar, Mohanta Bijan Kumar, Misra Dilip Kumar, De Palas
Radiation Oncology, Chittaranjan National Cancer Institute, Kolkata, India.
Rep Pract Oncol Radiother. 2023 Aug 28;28(4):468-477. doi: 10.5603/RPOR.a2023.0048. eCollection 2023.
Whole-brain radiotherapy is associated with neurocognitive decline and decreased quality-of-life (QOL) among survivors of brain metastasis. Hippocampal-avoidance whole-brain radiotherapy (HA-WBRT) has shown advantage in delaying or preventing the neurocognitive decline while maintaining disease control. This study was done to assess the benefits and feasibility of HA-WBRT in patients with cerebral metastasis in terms of preservation of neurocognitive function and quality of life.
27 patients with brain metastasis treated by HA-WBRT and having the records of detailed neurocognitive-assessments were analysed from the database of our hospital. The patients were treated with HA-WBRT to a total dose of 30 Gy in 10 fractions with LINAC based IMRT using the VMAT technique. Cognitive function assessment was carried out using "Examination of the Cognitive Functions" scale provided by Bangur-Institute-of-Neurosciences, Kolkata, 2 weeks prior to radiotherapy and post-treatment two-monthly up to 6 months followed by every 3 months till the last follow up. QOL was assessed at the same interval using the Functional Assessment of Cancer Therapy with Brain Subscale (FACT-BR). Follow-up was done till the date of death.
Mean relative cognitive decline percentage decreased over subsequent follow-up visits and was 13% (SD ± 6%), 5% (SD ± 5%), 5% (SD ± 9%) and 2% (SD ± 12%) at 2 months, 6 months, 9 months and 12 months, respectively (p ≤ 0.05). Statistically significant improvement was seen in the mean social-wellbeing (SWB) parameter of QOL (8%. ± 13%, 12%. ± 16%, 7%. ± 20%, no change at 2 months, 4 months, 6 months and 9 months, respectively) (p ≤ 0.05). Mean relative decline in the Emotional-Well Being (EWB) parameter was significant only at 12 months and was 20% (SD ± 35%) (p = 0.04). Mean FACT-BR total Score showed a slight decrease till 9 months from baseline, and then showed a slight improvement up to 12 months.
HA-WBRT is feasible with LINAC-based IMRT using the VMAT technique and beneficial to the patients in preserving neurocognitive function and quality of life without compromising disease control.
全脑放疗与脑转移瘤幸存者的神经认知功能下降和生活质量（QOL）降低相关。海马回避全脑放疗（HA-WBRT）在延迟或预防神经认知功能下降同时维持疾病控制方面已显示出优势。本研究旨在评估HA-WBRT在脑转移患者中对神经认知功能和生活质量的保护作用及可行性。
从我院数据库中分析27例接受HA-WBRT治疗且有详细神经认知评估记录的脑转移患者。患者采用基于直线加速器的容积调强放疗（VMAT）技术进行HA-WBRT，总剂量30 Gy，分10次。放疗前2周及放疗后每2个月直至6个月，然后每3个月直至最后一次随访，使用加尔各答班古尔神经科学研究所提供的“认知功能检查”量表进行认知功能评估。使用癌症治疗功能评估脑亚量表（FACT-BR）在相同时间间隔评估QOL。随访至死亡日期。
在随后的随访中，平均相对认知下降百分比降低，在2个月、6个月、9个月和12个月时分别为13%（标准差±6%）、5%（标准差±5%）、5%（标准差±9%）和2%（标准差±12%）（p≤0.05）。QOL的平均社会幸福感（SWB）参数有统计学显著改善（在2个月、4个月、6个月和9个月时分别为8%±13%、12%±16%、7%±20%，无变化）（p≤0.05）。情绪幸福感（EWB）参数的平均相对下降仅在12个月时显著，为20%（标准差±35%）（p = 0.04）。FACT-BR总分从基线到9个月略有下降，然后到12个月略有改善。
使用VMAT技术的基于直线加速器的IMRT进行HA-WBRT是可行的，对患者在保留神经认知功能和生活质量方面有益，且不影响疾病控制。
