Abstract Date: 5/1/2016
Anthony L. Asher, MD
S. Keith Anderson
Fred Barker II
Cynthia Menard (Charlotte, NC)
Introduction Whole brain radiotherapy (WBRT) significantly improves tumor control in the brain after radiosurgery, yet the role of WBRT remains controversial due to concerns regarding cognitive risks.
Methods Patients with one-three brain metastases were randomized to radiosurgery alone or radiosurgery plus WBRT, and underwent cognitive testing before and after treatment. Primary endpoint was cognitive deterioration (decline >1 SD from baseline in at least one cognitive test at 3 months).
Results 213 patients were enrolled. Cognitive deterioration at 3 months was more frequent after radiosurgery plus WBRT vs. radiosurgery alone (91.7% vs. 63.5%, p < 0.001). Patients receiving WBRT experienced more deterioration in immediate memory (30.4% vs. 8.2%, p = 0.004), delayed memory (51.1% vs. 19.7%, p< 0.001), and verbal fluency (18.6% vs. 1.9%, p=0.010). There was greater deterioration in QOL at 3 months with WBRT, notably functional well-being (p=0.006) and overall QOL (p=0.001). Intracranial tumor control at 3 months was 93.7% with WBRT vs. 75.3% with radiosurgery alone (p < 0.001). Median OS was 7.4 months for radiosurgery plus WBRT vs. 10.4 for radiosurgery (HR=1.02, p=0.920). For long-term survivors, cognitive deterioration was more frequent after radiosurgery plus WBRT at 3 months (94.1% vs. 45.5%, p=0.007); no differences were observed in quality of life and functional independence.
Conclusion: Decline in immediate/delayed memory and verbal fluency as well as QOL at 3 months were more frequent with the addition of WBRT to radiosurgery. Adjuvant WBRT did not improve OS despite improved intracranial tumor control. Long-term survivors receiving WBRT also had more cognitive decline.
Article ID: AA-34860