Evaluating the impact of whole brain radiotherapy with hippocampus sparing on neurocognitive functions in patients with brain metastases
Abstract
Purpose: In this prospective study, we aimed to evaluate neurocognitive functions (NCF) by applying mini-mental testing in whole brain radiotherapy (WBRT) patients with or without hippocampal sparing (HS).
Materials and methods: The study included 40 patients who underwent WBRT with brain metastases diagnosed between February 2024 and August 2024.
We used a Mini-Mental Status Examination (MMSE) test to compare NCF scores at baseline to two and four months after starting WBRT. The MMSE (Mini-Mental Status Examination Score) test could be performed in the fourth month on 30 of the 40 patients undergoing WBRT who were in good general health. Hippocampal sparing was applied in whole-brain radiotherapy planning in 14 of the 30 patients, but the hippocampal dose was higher for two patients. Hippocampal sparing was not applied in the whole brain radiotherapy plan of 16 patients. The effect of WBRT with HS or WBRT without HS on neurocognitive function was assessed in on 30 patients in this study for changes and decreases at baseline, two months, and four months later.
Results: The mini mental test scores of patients undergoing whole brain radiation therapy with and without hippocampus sparing did not significantly alter before and after treatment, according to our study (p=0.59). When evaluated by age, neurocognitive functions decreased after WBRT in patients aged 65 and older (Baseline test Score 26.67; 4-Month Post-test Score 25.5 p=0.06). However, there was no decrease in neurocognitive functions in patients under the age of 65 receiving WBRT (p=0.06). Neurocognitive function test scores in patients 65 years of age and older decreased in those without hippocampal sparing WBRT compared to the pre-radiation therapy test (Baseline test Score 26.14; 4-Month Post-test Score 24 p=0.06); however, test scores in those with hippocampal sparing WBRT did not decrease after two or four months (Baseline test Score 27.40; 4-Month Post-test Score 27.6 p=0.06). The p-value was quite close, but not statistically significant.
Conclusion: Neurocognitive functions were not different between patients with brain metastases under the age of 65 who received WBRT with hippocampus sparing versus those who received WBRT without hippocampal sparing. In our study of patients aged 65 and older, we found that WBRT with hippocampus sparing was associated with memory preservation in neurocognitive function test outcomes. WBRT with hippocampus sparing can be used to preserve cognitive function in the elderly with brain metastases.
Keywords
Hippocampal sparing, whole brain radiotherapy, neurocognitive function, brain metastases, elderly patients
Ethical Statement
The study protocol was approved by the Medical Ethics Committee at Pamukkale University (date: 20.02.2024 and number: 2024/04).
Thanks
We would like to thank medical statistician Hande Senol of the Department of Medical Statistics, School of Medicine, University of Pamukkale.
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