Individualized trajectories in post-radiotherapy neurocognitive functioning of patients with brain metastases

IF 2.4 Q2 CLINICAL NEUROLOGY

Neuro-oncology practice Pub Date : 2024-03-29 DOI:10.1093/nop/npae024

E. V. van Grinsven, F. Cialdella, Y. Gmelich Meijling, Joost J C Verhoeff, Marielle M Philippens, M. V. van Zandvoort

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Abstract

The increasing incidence of brain metastases (BMs) and improved survival rates underscore the necessity to investigate the effects of treatments on individuals. The aim of this study was to evaluate the individual trajectories of subjective and objective cognitive performance after radiotherapy in patients with BMs. The study population consisted of adult patients with BMs referred for radiotherapy. A semi-structured interview and comprehensive neurocognitive assessment (NCA) were used to assess both subjective and objective cognitive performance before, 3 months and ≥11 months after radiotherapy. Reliable change indices were used to identify individual, clinically meaningful changes. Thirty-six patients completed the 3-month follow-up, and 14 patients completed the ≥11-months follow-up. Depending on the domain, subjective cognitive decline was reported by 11-22% of patients. In total, 50% of patients reported subjective decline on at least one cognitive domain. Intracranial progression 3 months post-radiotherapy was a risk-factor for self-reported deterioration (p=.031). Objective changes were observed across all domains, with a particular vulnerability for decline in memory at 3 months post-radiotherapy. The majority of patients (81%) experienced both a deterioration as well as improvement (e.g. mixed response) in objective cognitive functioning. Results were similar for the long-term follow-up (3-≥11 months). No risk factors for objective cognitive change 3 months post-radiotherapy were identified. Our study revealed that the majority of patients with BMs will show a mixed cognitive response following radiotherapy, reflecting the complex impact. This underscores the importance of patient-tailored NCAs three months post-radiotherapy to guide optimal rehabilitation strategies.

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脑转移患者放疗后神经认知功能的个体化轨迹

脑转移瘤（BMs）发病率的增加和存活率的提高凸显了研究治疗对个体影响的必要性。本研究旨在评估脑转移瘤患者放疗后主观和客观认知表现的个体轨迹。研究对象包括转诊接受放疗的成年肿瘤患者。采用半结构化访谈和综合神经认知评估（NCA）来评估放疗前、放疗后3个月和≥11个月的主观和客观认知表现。可靠的变化指数用于识别个体的、有临床意义的变化。 36名患者完成了3个月的随访，14名患者完成了≥11个月的随访。根据不同的领域，11%-22%的患者报告了主观认知能力下降。总共有 50% 的患者报告在至少一个认知领域出现主观下降。放疗后3个月的颅内进展是导致自我报告认知能力下降的风险因素（p=0.031）。在所有领域都观察到了客观变化，尤其是放疗后3个月记忆力下降。大多数患者（81%）的客观认知功能既有恶化，也有改善（如混合反应）。长期随访（3-≥11 个月）的结果与此类似。没有发现放疗后3个月客观认知变化的风险因素。我们的研究表明，大多数 BMs 患者在放疗后会出现不同的认知反应，这反映了放疗的复杂影响。这强调了放疗后三个月根据患者情况进行NCA以指导最佳康复策略的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Neuro-oncology practice CLINICAL NEUROLOGY-

CiteScore

5.30

自引率

11.10%

发文量

期刊介绍： Neuro-Oncology Practice focuses on the clinical aspects of the subspecialty for practicing clinicians and healthcare specialists from a variety of disciplines including physicians, nurses, physical/occupational therapists, neuropsychologists, and palliative care specialists, who have focused their careers on clinical patient care and who want to apply the latest treatment advances to their practice. These include: Applying new trial results to improve standards of patient care Translating scientific advances such as tumor molecular profiling and advanced imaging into clinical treatment decision making and personalized brain tumor therapies Raising awareness of basic, translational and clinical research in areas of symptom management, survivorship, neurocognitive function, end of life issues and caregiving