Clinical Study Of Cognitive Impairment In Patients With Brain Metastases From Lung Cancer After Radiation Therapy

Objective The study is to analyze the efficacy of patients with brain metastases from lung cancer by comparing the way of multiple gamma knife and whole brain radiotherapy plus gamma knife,and is to assess the effect of two treatments on cognitive function and quality of life.Methods We analyzed retrospectively 60 cases with brain metastases from lung cancer,which were treated with multiple gamma knife or whole brain radiotherapy plus gamma knife from September 2014 to September 2016 in the Inner Mongolia medical university affiliated hospital.The age of patients was 35 to 75 years(mean age was 58.4±9.3 years).Primary tumors were diagnosed by pathology and brain metastases were diagnosed by enhanced MRI.Gamma knife with a margin dose of 12~16 Gy,at isodose curve of 40%~50% for the prescription dose,the central dose of 24~35 Gy.Whole brain radiotherapy DT 30~40 Gy,2~3 Gy per fraction,5 times per week,2~4 weeks to complete.KPS and MMSE assessments were conducted at 1 week before therapy,KPS assessment was conducted at 2 weeks and MMSE assessment was conducted at every 3 months after completion of therapy,to evaluate the patient's cognitive function and quality of life.The WHO therapeutic effect evaluation criteria was used to evaluate the local tumor control rate.Kaplan-Meier method was used to describe the survival process.The log-rank test was used to compare differences in the survival curve between multiple gamma knife and whole brain radiotherapy plus gamma knife.Results The MMSE scores of the two groups were significantly different,by F test P=0.001<0.05.Compared with baseline MMSE score,the multiple gamma knife group had no difference in different time points after therapy,and there was no difference in times.It is showed that there was no significant decreased in the cognitive scores of the patients with multiple gamma knife group.Compared with baseline MMSE score,the whole brain radiotherapy plus gamma knife group had significant difference in different time points after therapy,and there was significant decreased in times.It is showed that there was significant decreased in the cognitive scores of the patients with whole brain radiotherapy plus gamma knife group.Compared with the multiple gamma knife group MMSE score,the whole brainradiotherapy plus gamma knife group had a significant decline in 3 months,6 months and 9 months after therapy,there was significant difference by t test P<0.05.Compared with 1 week before therapy,all patient's KPS scores had significant difference in 2 weeks after therapy,by the chi-square test P<0.05,it is showed that the gamma knife radiosurgery can soon relieve the patient's symptoms and significant improve quality of life.At 3 months after therapy to review the enhance MRI,the multiple gamma knife group CR 8 patients,PR 17 patients,SD 3 patients,PD 2 patients,the local tumor control rate was 83.3%.The whole brain radiotherapy plus gamma knife group CR 7 patients,PR 19 patients,SD 3 patients,PD 1 patient,the local tumor control rate was 86.7%,there was no difference by the chi-square test P =1.000>0.05,the two treatments had no difference in recent local tumor control rate.The median survival time of the multiple gamma knife group was 18 mouths,the whole brain radiotherapy plus gamma knife group was 14 mouths,there was no difference by the chi-square test P = 0.460>0.05,it is showed that the two treatments had no difference in the survival curve.Conclusion Multiple gamma knife radiosurgery in patients with brain metastases from lung cancer have a better local tumor control rate and survival time,and can effectively protect the patient's cognitive function,improve the patient's quality of life,and it provided the opportunities of patients get advanced chemotherapy and other supportive treatments to improve the prognosis.Therefore,we believe that multiple gamma knife radiosurgery in patients with brain metastases from lung cancer is a good treatment option.