Neurocognition and Quality of Life for Hypofractionated Stereotactic Radiotherapy (HFSRT) of the Resection Cavity vs. Whole-Brain Radiotherapy (WBRT) Following Brain Metastasis Resection – Results of the ESTRON Randomized Phase 2 Trial
{"title":"Neurocognition and Quality of Life for Hypofractionated Stereotactic Radiotherapy (HFSRT) of the Resection Cavity vs. Whole-Brain Radiotherapy (WBRT) Following Brain Metastasis Resection – Results of the ESTRON Randomized Phase 2 Trial","authors":"","doi":"10.1016/j.ijrobp.2024.07.058","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose/Objective(s)</h3><div>The ESTRON randomized phase 2 trial compared post-operative hypofractionated stereotactic radiotherapy (HFSRT) of the resection cavity following brain metastases (BM) resection with post-operative whole-brain radiotherapy (WBRT) in patients with 1-10 BM. We previously presented local control (LC), intracranial control (IC) and overall survival (OS). Neurocognitive function and quality of life were pre-specified secondary endpoints.</div></div><div><h3>Materials/Methods</h3><div>Neurocognitive testing included the Hopkins Verbal Learning Test-Revised (HVLT-R) total recall (TR) and delayed recall (DR). A drop of ≥ 5 points from baseline in HVLT-R total recall was considered clinically relevant. Health-related Quality of Life (hr-QoL) was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C15 PAL questionnaire and brain module (BN-20). All Assessments were performed at baseline, 6-8 weeks after treatment and three-monthly afterwards for 12 months.</div></div><div><h3>Results</h3><div>Fifty-four patients were randomized; HFSRT <em>n</em> = 27, WBRT <em>n</em> = 27. HFSRT provided 3-year LC of 96% with similar IC and OS between groups, as reported previously. Median baseline HVLT-R score was 24.0 (Q1-Q3 = 18-27) in the HFSRT-group vs. 26.0 (Q1-Q3 = 22-28) in the WBRT-group for TR subscale and 8.0 (Q1-Q3 = 5-10, HFSRT-group) vs. 9.5 (Q1-Q3 = 8-12, WBRT-group) for DR subscale. A drop of ≥ 5 points from baseline occurred in 5 patients (18.5%) in the HFSRT-group vs. 8 patients (29.6%) in the WBRT group (risk difference 0.11, 95% CI = [-0.34 to 0.12], <em>P</em> = 0.34). Maximum change in median HVLT-R TR score was +8.3% (Q1-Q3 = 23-34, HFSRT-group) vs. -11.5% (Q1-Q3 = 18-28, WBRT-group) at 31 weeks from baseline (<em>P</em> = 0.079). At no timepoint did the median HVLT-R TR score decline from baseline in the HFSRT-group. For DR subscale, median change from baseline was +17.6% (Q1-Q3 = 8-12, HFSRT-group) vs. -15.8% (Q1-Q3 = 4-10, WBRT-group) at 31 weeks (<em>P</em> = 0.246). Overall hr-QoL (QLQ-C15 PAL) was similar in both groups. Regarding functional subscales, in the WBRT-group a relevant increase in nausea/vomiting (mean +33.3, standard deviation (SD) = 13.4 points, <em>P</em> = 0.001) and appetite loss (mean +40.3, SD = 32.6 points, <em>P</em> < 0.001) was observed 7 weeks from baseline with no respective change in the HFSRT-group. The other functional scales of QLQ-C15 PAL and BN-20 were not relevantly different between groups.</div></div><div><h3>Conclusion</h3><div>While providing excellent local control, HFSRT following BM resection preserves neurocognition more effectively than WBRT, with differences most pronounced at 7 months from baseline. Overall hr-QoL was similar, although WBRT acutely worsened nausea and appetite loss.</div></div>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":null,"pages":null},"PeriodicalIF":6.4000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Radiation Oncology Biology Physics","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0360301624008204","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Purpose/Objective(s)
The ESTRON randomized phase 2 trial compared post-operative hypofractionated stereotactic radiotherapy (HFSRT) of the resection cavity following brain metastases (BM) resection with post-operative whole-brain radiotherapy (WBRT) in patients with 1-10 BM. We previously presented local control (LC), intracranial control (IC) and overall survival (OS). Neurocognitive function and quality of life were pre-specified secondary endpoints.
Materials/Methods
Neurocognitive testing included the Hopkins Verbal Learning Test-Revised (HVLT-R) total recall (TR) and delayed recall (DR). A drop of ≥ 5 points from baseline in HVLT-R total recall was considered clinically relevant. Health-related Quality of Life (hr-QoL) was assessed using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C15 PAL questionnaire and brain module (BN-20). All Assessments were performed at baseline, 6-8 weeks after treatment and three-monthly afterwards for 12 months.
Results
Fifty-four patients were randomized; HFSRT n = 27, WBRT n = 27. HFSRT provided 3-year LC of 96% with similar IC and OS between groups, as reported previously. Median baseline HVLT-R score was 24.0 (Q1-Q3 = 18-27) in the HFSRT-group vs. 26.0 (Q1-Q3 = 22-28) in the WBRT-group for TR subscale and 8.0 (Q1-Q3 = 5-10, HFSRT-group) vs. 9.5 (Q1-Q3 = 8-12, WBRT-group) for DR subscale. A drop of ≥ 5 points from baseline occurred in 5 patients (18.5%) in the HFSRT-group vs. 8 patients (29.6%) in the WBRT group (risk difference 0.11, 95% CI = [-0.34 to 0.12], P = 0.34). Maximum change in median HVLT-R TR score was +8.3% (Q1-Q3 = 23-34, HFSRT-group) vs. -11.5% (Q1-Q3 = 18-28, WBRT-group) at 31 weeks from baseline (P = 0.079). At no timepoint did the median HVLT-R TR score decline from baseline in the HFSRT-group. For DR subscale, median change from baseline was +17.6% (Q1-Q3 = 8-12, HFSRT-group) vs. -15.8% (Q1-Q3 = 4-10, WBRT-group) at 31 weeks (P = 0.246). Overall hr-QoL (QLQ-C15 PAL) was similar in both groups. Regarding functional subscales, in the WBRT-group a relevant increase in nausea/vomiting (mean +33.3, standard deviation (SD) = 13.4 points, P = 0.001) and appetite loss (mean +40.3, SD = 32.6 points, P < 0.001) was observed 7 weeks from baseline with no respective change in the HFSRT-group. The other functional scales of QLQ-C15 PAL and BN-20 were not relevantly different between groups.
Conclusion
While providing excellent local control, HFSRT following BM resection preserves neurocognition more effectively than WBRT, with differences most pronounced at 7 months from baseline. Overall hr-QoL was similar, although WBRT acutely worsened nausea and appetite loss.
期刊介绍:
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.