Neurocognitive Functions after Stereotactic Radiosurgery - An Analysis with Mini-Mental State Examination (MMSE)

Background: Throughout the past decade, the research on neuro-oncology has increased awareness regarding the significance of cognitive functions as an outcome in different treatment modalities for patients with a primary brain tumor but only limited studies have explored the subject of the likelihood of cognitive dysfunction in patients undergoing stereotactic radiosurgery/stereotactic radiotherapy (SRS/SRT). This, modern radiation delivery technique allows high-dose delivery to the target and minimum dose to the brain/critical organs resulting in better tumor control and perhaps an improvement in Neurocognitive functions (NCF). Objectives: To explore the effect of stereotactic radiosurgery/stereotactic radiotherapy on neurocognitive functions (NCF) in various brain tumors. Methods: A prospective observational study was conducted at Neurospinal and Cancer Care Institute (NCCI), Karachi. A total of 100 patients who had undergone multisession stereotactic radiosurgery /stereotactic radiotherapy were selected after taking their written informed consent by employing a convenient sampling technique. The type of tumor was classified and identified on a radiological and histological basis. Neurocognitive function evaluation was carried out through Mini-Mental State Examination (MMSE) score questionnaire provided to patients at baseline (pre-radiosurgery SRS/SRT), and 6 months after treatment (post-radiosurgery SRS/SRT). Results: The mean age of patients was 37.38±15.03 years and the majority (49%) belonged to the 27-44 years age group. The majority of them were males whereas the most common pathology found was glioma (31%). Moreover, both overall and in patients having prior surgery, the comparison of different MMSE score levels showed that there was a significant increase in patients with normal score levels and a significant decrease in patients with mild and moderate score levels after treatment (P=0.006 and P=0.046 respectively) at post-treatment time. Conclusion: Stereotactic radiosurgery results in the improvement of neurocognitive functions. Previously known radiation-related impairment of NCF should be re-explored in light of modern radiosurgery/radiotherapy techniques with larger studies.