Main Session
Sep 28
SS 01 - CNS 1: Novel Approaches in Brain Metastases

106 - Prospective Interventional Study Investigating the Neurocognitive Effects and Quality of Life (QOL) in Patients with Brain Metastases, Comparing Hippocampal Avoidance Whole-Brain Radiation Therapy (HA-WBRT) with SIB to SRS/FSRT

03:30pm - 03:40pm PT
Room 152

Presenter(s)

Souvik Sankar Das, MBBS Headshot
Souvik Sankar Das, MBBS - Chittaranjan National Cancer Institute, Kolkata, West Benga

S. S. Das1, A. Ray2, D. K. Ray1, S. Kundu3, K. Mazumder4, B. Pramanik2, M. Mahawar5, and B. Dutta1; 1CHITTARANJAN NATIONAL CANCER INSTITUTE, KOLKATA, India, 2Chittaranjan National Cancer Institute, Kolkata, India, 3Chittaranjan National Cancer Institute, Kolkata, India, 4Chittaranjan National Cancer Institute, KOLKATA, India, 5Chittaranjan National Cancer Institute, Kolkata, West Benga, India

Purpose/Objective(s):

Whole Brain Radiation Therapy (WBRT) is linked to decreased quality of life, primarily due to its adverse effects on neurocognitive function, particularly episodic memory, which is the most significantly impacted domain.

In this study, primarily we are comparing prospectively the neurocognitive function & QOL between two groups of patients having limited number of brain metastases receiving HA-WBRT+SIB vs SRS/FSRT.

Materials/Methods:

A total of 84 patients with limited brain metastases were randomly allocated to two treatment arms. In the HA-WBRT arm, patients received 30 Gy in 10 fractions with a simultaneous integrated boost of 40-45 Gy in 10 fractions to the SOL depending on location. In contrast, patients in the SRS/FSRT arm received doses tailored to tumor size and location, as per the RTOG 9005 protocol.

Neurocognitive function was evaluated using the Hopkins Verbal Learning Test-Revised (HVLT-R) at baseline and during post-treatment follow-ups at 1st, 2nd and 4th months. Quality of life was assessed in parallel at the same intervals using the EORTC C30 and BN20 validated questionnaires.

Results:

Neurocognitive mean relative shift from baseline measured by HVLT-R Delayed Recall revealed at 4th month follow up were +0.42 and +0.47 respectively in SRS/FSRT and HA-WBRT + SIB arm which were almost equal. Preservation as well as improvement of neurocognitive function observed but general & neurological symptom specific QOL declined in several aspects in both arms. There is no statistically significant difference between the 2 groups at 4th month follow up in terms of QOL (GHS-C30, PF-C30, CF-C30, MD-BN20, CD-BN20).

Conclusion:

With this finding of comparative analysis of neurocognitive function between both the arms, we can safely conclude that HA-WBRT+ SIB should also be considered as standard for a fair trade-off between neurocognitive function/quality of life and intracranial control. Most patients showed preservation or enhancement of neurocognitive function, potentially attributable to initially compromised baseline cognition. But, the overall health-related quality of life largely declined, primarily constrained by subsite-specific prognosis and progression of the underlying primary disease. Further investigation using a disease-specific Graded Prognostic Assessment (dsGPA) is necessary to subgroup-specific outcomes and to optimize patient management