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Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial

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Abstract

Intraoperative permanent Cesium-131 (Cs-131) brachytherapy can provide a viable alternative to WBRT with excellent response rates and minimal toxicity. This study reports the results of the prospective trial of the impact of intraoperative Cs-131 on neurocognitive function and quality of life (QoL) in patients with resected brain metastases. Between 2010 and 2012, 24 patients with newly diagnosed metastasis to the brain were accrued on a prospective protocol and treated with Cs-131 brachytherapy seeds after surgical resection. Physicians administered the mini-mental status examination (MMSE) and functional assessment of cancer therapy-brain (FACT-Br) questionnaire to all patients before treatment and again every 2 months for the duration of 6 months with additional follow-up again at 12 months. Wilcoxon rank sum test was used to analyze statistically significant changes in MMSE over time and paired t test was used to analyze changes in FACT-BR. There was a statistical improvement in overall FACT-BR score at 4 and 6 months of follow-up when compared to baseline (162 vs. 143, P = 0.004; 164 vs. 143, P = 0.005 respectively) with a non-significant trend toward improvement at 2 and 12 months (154 vs. 143, P = 0.067; 159 vs. 149, P = 0.4). MMSE score was statistically improved at 4 and up to 12 months compared to pre-treatment MMSE (30 vs. 29, P = 0.017; 30 vs. 29, P = 0.001 respectively). Patients with brain metastasis who received intra-operative permanent Cs-131 brachytherapy implants saw an improvement of their neurocognitive status and self-assessment of QoL. In addition to the excellent local control of metastasis, this approach may contribute to the improvements in cognitive function and QOL.

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Abbreviations

WBRT:

Whole brain radiotherapy

Cs-131:

Cesium-131

SRS:

Stereotactic radiosurgery

NCF:

Neurocognitive function

MMSE:

Mini mental status exam

Qol:

Quality of life

FFP:

Freedom from progression

FACT-Br:

Functional assessment of cancer therapy brain

OS:

Overall survival

I-125:

Iodine-125

HSRT:

Hypofractionated stereotactic radiotherapy

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Author information

Authors and Affiliations

  1. Weill Cornell Medical College, New York, NY, USA

    Anthony Pham

  2. New York-Presbyterian/Weill Cornell Medical Center, New York, NY, USA

    Menachem Z. Yondorf, Bhupesh Parashar & A. Gabriella Wernicke

  3. Department of Radiation Oncology, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street at York Avenue, New York, NY, 10065, USA

    Menachem Z. Yondorf, Bhupesh Parashar & A. Gabriella Wernicke

  4. Department of Medical Oncology, Brain and Spine Center, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street, Starr 651, Box 99, New York, NY, 10065, USA

    Ronald. J. Scheff

  5. Department of Neurosurgery, Brain and Spine Center, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 525 E. 68th Street, Starr 651, Box 99, New York, NY, 10065, USA

    Susan C. Pannullo, Rohan Ramakrishna, Philip E. Stieg, Theodore H. Schwartz & A. Gabriella Wernicke

  6. Department of Otorhinolaryngology, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 1305 York Avenue, 5th Floor, New York, NY, 10065, USA

    Theodore H. Schwartz

  7. Department of Neuroscience, Weill Cornell Medical College/NewYork-Presbyterian Hospital, 520 E. 70th Street (at York Avenue), Starr Pavilion 607, New York, NY, 10065, USA

    Theodore H. Schwartz

  8. Stich Radiation Oncology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY, 10065, USA

    A. Gabriella Wernicke

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  1. Anthony Pham
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Correspondence to A. Gabriella Wernicke.

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Pham, A., Yondorf, M.Z., Parashar, B. et al. Neurocognitive function and quality of life in patients with newly diagnosed brain metastasis after treatment with intra-operative cesium-131 brachytherapy: a prospective trial. J Neurooncol 127, 63–71 (2016). https://doi.org/10.1007/s11060-015-2009-5

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