Beyin metastazlı hastalarda hipokampus korumalı tüm beyin radyoterapinin nörobilişsel fonksiyonlar üzerine etkisi

Öz

Amaç: Bu prospektif çalışmada hipokampal koruma yapılan ya da yapılmayan tüm beyin radyoterapili (TBRT)olgularda mini-mental test uygulayarak nörobilişsel fonksiyonları değerlendirmeyi amaçladık. Gereç ve yöntem: Çalışmaya Şubat 2024- Ağustos 2024 tarihleri arasında beyin metastazlı tüm beyin radyoterapi alan 40 hasta dahil edildi. Biz nörokognitif fonksiyon skorlarını karşılaştırmak için mini-mental testi TBRT başlamadan önce, 2. ayda ve 4. ayda kullandık. Genel durumu iyi olan 40 hastanın 30’unda 4. ay minimental test uygulanabildi. 30 hastanın 14'ünde tüm beyin radyoterapisi (TBRT) planlamasında hipokampal koruma uygulandı, ancak 2 hasta için hipokampal doz daha yüksek bulundu. 16 hastanın tüm beyin radyoterapi planında ise hipokampal koruma uygulanmadı. Hipokampal korumalı ya da korumasız tüm beyin radyoterapi başlamadan önce, iki ve dört ayda Mini Mental Durum Muayenesi testi ile nörobilişissel fonksiyon değişiklikleri ve azalmayı 30 hastada değerlendirdik. Bulgular: Çalışmamızda hipokampal koruyucu olan ve olmayan tüm beyin radyoterapi alan hastaların tedavi öncesi ve sonrası mini mental test puanlarında anlamlı bir değişiklik bulunmadı (p=0,59). Yaşa göre değerlendirildiğinde 65 yaş ve üstü hastalarda nörobilişsel fonksiyonların TBRT ardından azaldığı görüldü (TBRT öncesi test skor 26,67; 4. ay test skor 25,5 p=0,06). 65 yaşın altındaki TBRT alan hastalarda nörobilişsel fonksiyonlarda azalma görülmedi (p=0,06). 65 yaş üstü hastalarda hipokampus koruyucusuz TBRT alanlarda nörobilişsel fonksiyon test puanlarında radyoterapi öncesi teste göre azalma görülmesine rağmen (TBRT öncesi test skor 26,14; 4. ay test skor 24 p=0,06), hipokampal koruyuculu – TBRT alanlarda 2 veya 4 ay sonra yapılan test puanlarında düşme görülmedi (TBRT öncesi test skor 27,4; 4. ay test skor 27,6 p=0,06). İstatistiksel anlamlı olmamasına rağmen p değeri anlamlıya oldukça yakındı. Sonuç: 65 yaşın altındaki beyin metastazlı hastalarda hipokampal koruma yapılanlar ile hipokampal koruma yapılmayanlar karşılaştırıldığında nörokognitif fonksiyonlarda herhangi bir farklılık görülmemiştir. Bizim çalışmamızda 65 yaş ve üstü hastalarda hipokampal korumalı TBRT’nin nörobilişsel fonksiyon test sonuçlarında hafızayı korumada etkili olduğu yönünde bir eğilim görüldü. Hipokampal koruyuculu TBRT beyin metastazı olan yaşlı bireylerde bilişsel işlevi korumak için kullanılabilir.

Anahtar Kelimeler

• Hipokampal koruma
• tüm beyin radyoterapi
• nörobilişsel fonksiyon
• beyin metastazları
• yaşlı hastalar

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

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