Prospective Evaluation of Quality of Life and Neurocognitive Effects in Patients With Multiple Brain Metastases Receiving Whole-Brain Radiotherapy With or Without Thalidomide on Radiation Therapy Oncology Group (RTOG) Trial 0118

Corn, Benjamin W.; Moughan, Jennifer; Knisely, Jonathan P.S.; Fox, Sherry W.; Chakravarti, Arnab; Yung, W.K. Alfred; Curran, Walter J.; Robins, H. Ian; Brachman, David G.; Henderson, Randal H.; Mehta, Minesh P.; Movsas, Benjamin

doi:10.1016/j.ijrobp.2007.09.015

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 71, Issue 1 , Pages 71-78, 1 May 2008

Prospective Evaluation of Quality of Life and Neurocognitive Effects in Patients With Multiple Brain Metastases Receiving Whole-Brain Radiotherapy With or Without Thalidomide on Radiation Therapy Oncology Group (RTOG) Trial 0118

Benjamin W. Corn, M.D.
- Department of Radiation Oncology, Tel Aviv Medical Center, Tel Aviv, Israel
- Reprint requests to: Benjamin W. Corn, M.D., Institute of Radiotherapy, Tel Aviv Medical Center, 6 Weizman Street, Tel Aviv, Israel. Tel: (+972) 52-426-6533; Fax: (+972) 3-697-7285
Jennifer Moughan, M.S.
- Statistical Unit of the Radiation Therapy Oncology Group (RTOG), Philadelphia, PA
Jonathan P.S. Knisely, M.D., F.R.C.P.C.
- Department of Radiation Oncology, Yale University, New Haven, CT
Sherry W. Fox, R.N., Ph.D.
- Cullather Brain Tumor Quality of Life Center, Richmond, VA
Arnab Chakravarti, M.D.
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA
W.K. Alfred Yung, M.D.
- Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, TX
Walter J. Curran Jr., M.D.
- Department of Radiation Oncology, Emory University, Atlanta, GA
H. Ian Robins, M.D., Ph.D.
- Department of Radiation Oncology, University of Wisconsin, Madison, WI
David G. Brachman, M.D.
- Department of Radiation Oncology, St. Joseph's Hospital, Phoenix, AZ
Randal H. Henderson, M.D., M.B.A.
- Department of Radiation Oncology, University of Florida, Gainesville, FL
Minesh P. Mehta, M.D.
- Department of Radiation Oncology, University of Wisconsin, Madison, WI
Benjamin Movsas, M.D.
- Department of Radiation Oncology, Henry Ford Hospital, Detroit, MI

Received 19 June 2007; received in revised form 13 September 2007; accepted 14 September 2007. published online 03 January 2008.

Purpose

Radiation Therapy Oncology Group (RTOG) 0118 randomized patients with multiple brain metastases to whole-brain radiotherapy (WBRT) ± thalidomide. This secondary analysis of 156 patients examined neurocognitive and quality of life (QOL) outcomes.

Methods and Materials

Quality of life was determined with the Spitzer Quality of Life Index (SQLI). The Folstein Mini-Mental Status Exam (MMSE) assessed neurocognitive function. SQLI and MMSE were administered at baseline and at 2-month intervals. MMSE was scored with a threshold value associated with neurocognitive functioning (absolute cutoff level of 23) and with the use of corrections for age and educational level.

Results

Baseline SQLI predicted survival. Patients with SQLI of 7–10 vs. <7 had median survival time (MST) of 4.8 vs. 3.1 months, p = 0.05. Both arms showed steady neurocognitive declines, but SQLI scores remained stable. Higher levels of neurocognitive decline were observed with age and education-level corrections. Of patients considered baseline age/educational level neurocognitive failures, 32% died of intracranial progression.

Conclusions

Quality of life and neuropsychological testing can be prospectively administered on a Phase III cooperative group trial. The MMSE should be evaluated with adjustments for age and educational level. Baseline SQLI is predictive of survival. Despite neurocognitive declines, QOL remained stable during treatment and follow-up. Poor neurocognitive function may predict clinical deterioration. Lack of an untreated control arm makes it difficult to determine the contribution of the respective interventions (i.e., WBRT, thalidomide) to neurocognitive decline. The RTOG has developed a trial to study the role of preventative strategies aimed at forestalling neurocognitive decline in this population.

Brain metastases, Whole-brain radiotherapy, Thalidomide, Quality of life, Neurocognition