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Neurological outcome and memory performance in patients with 10 or more brain metastases treated with frameless linear accelerator (LINAC)-based stereotactic radiosurgery

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Abstract

Purpose

To assess the neurocognitive function and neurological toxicity of frameless linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) in patients with 10 or more brain metastases (BM).

Patients and methods

Forty consecutive adult patients who received SRS for ten or more 10 BM < 3 cm in maximum size were evaluated. All plans were generated using a single-isocenter multiple-target (SIMT) SRS technique with doses of 22 Gy for lesions < 2 cm and 16–18 Gy for those ≥ 2 cm in size. Survival analyses were estimated by Kaplan–Meier method from the date of SRS. Neurocognitive function using the Hopkins verbal learning test-revised (HVLT-R) and activity of daily living scale (ADLS) were collected prospectively at baseline and at 3,6 and 12-month follow-up. Toxicity was assessed by the National Cancer Institute Common Toxicity Criteria for Adverse Events (Version 5.0).

Results

With a median follow-up of 10.8 months, 1-year survival and local control rates were 65% and 86%, respectively. Grade 2 or 3 toxicity occurred in eleven patients, being associated with radiological changes suggestive of radiation necrosis in seven patients. Three months after SRS, the mean relative decline was 14.2% for HVLT-R delayed recall, 12.3% for HVLT-R recognition, and 9.8% for HVLT-R total recall. A significant deterioration of HVLT-R scores ranged from 5.5 to 18.7% of patients at different time points. ADLS scores declined over time, but changes were not significant.

Conclusions

SRS is an effective and safe approach for patients with 10 or more BM able to maintain the pretreatment neurocognitive function in the majority of patients.

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Funding

The authors received no specific funding for this work.

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Authors and Affiliations

  1. Department of Medicine, Surgery and Neuroscience, Radiation Oncology Unit, University of Siena, Siena, Italy

    Minniti Giuseppe

  2. Radiation Oncology Unit, University of Pittsburgh Medical Center Hillman Cancer Center, San Pietro Hospital FBF, Rome, Italy

    Capone Luca, Nardiello Barbara, El Gawhary Randa, Raza Giorgio, Scaringi Claudia, Bianciardi Federico & Gentile Piercarlo

  3. IRCCS Neuromed, 86077, Pozzilli, IS, Italy

    Paolini Sergio

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  1. Minniti Giuseppe
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Correspondence to Minniti Giuseppe.

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This study has been approved by local Institutional Ethical Committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Minniti, G., Capone, L., Nardiello, B. et al. Neurological outcome and memory performance in patients with 10 or more brain metastases treated with frameless linear accelerator (LINAC)-based stereotactic radiosurgery. J Neurooncol 148, 47–55 (2020). https://doi.org/10.1007/s11060-020-03442-7

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